Defervescence of enteric fever in children treated with ceftriaxone: A hospital-based study in Nepal

Abstract Background: Enteric fever (EF) continuous to be a serious health threat in Nepal and children are mostly affected from this systemic illness with gruesome complications if left untreated. Accurate diagnosis and appropriate antimicrobial therapy still remain a challenge here. Though ceftriaxone is used as the drug of choice in hospitalized patients, there are concerns on emerging cephalosporin resistance in adults, though not reported in children yet. The objectives of this study were to assess the defervescence time and outcomes of children hospitalized with EF treated with ceftriaxone.Methods: This prospective observational study was conducted at Kathmandu tertiary hospital, Nepal for 12 consecutive months. Children (5-16 years) diagnosed with enteric fever using WHO or validated clinical diagnostic criteria were eligible for recruitment. After taking written informed consent, enrolled children were treated as per the institutional treatment protocol with a same brand of ceftriaxone of standard daily dose and duration of 7 days for uncomplicated and 10 days for complicated. Data on defervescence time, treatment outcomes and their clinical and laboratory profile were collected in the predesigned proforma and analyzed.Results: Of 106 enrolled children, the predominant manifestations were headache (95.3%), loss of appetite (94.3%) and abdominal pain (90.6%). The main laboratory findings were positive Widal test (74%) and thrombocytopenia (50%). Nine children (8.5%) showed blood culture positivity. Salmonella typhi with nalidixic acid resistant strains and Salmonella paratyphi A were isolated (2:1) and were sensitive to ceftriaxone (100%). The defervescence mean time was 3.94 days (± 0.96 SD). Children with positive blood culture had significantly longer defervescence time than those with negative culture (4.56 versus 3.89 days; p=0.04). One child developed complication (pneumonia). No children died or encountered treatment failure. Thrombophlebitis (38.7%) was the only adverse effect of ceftriaxone. Conclusion: Ceftriaxone of once daily dosing regimen exhibited safe and satisfactory treatment outcomes with approximate four days to defervescence. Ceftriaxone can still be drug of choice for the treatment of EF in hospitalized children. Further studies with a greater number of isolates for the classical clinical profile of EF and cephalosporin susceptibility in children may confirm or refute these findings.