Comparison of Culture Proven Enteric Fever Treatment with Meropenem Alone Vs Combination of Meropenem and Azithromycin

Background: Enteric fever, primarily caused by Salmonella enterica serotypes Typhi and Paratyphi, remains a significant global health challenge, particularly in regions with limited access to clean water and sanitation. The emergence of multidrug-resistant strains has prompted the exploration of effective antibiotic regimens. While Meropenem has become a critical treatment option, the potential benefit of combining it with Azithromycin is not well established. Objective: The study aimed to compare the efficacy of Meropenem alone versus a combination of Meropenem and Azithromycin in the treatment of culture-proven enteric fever, focusing on fever resolution time and hospital stay duration. Methods: Conducted at the Combined Military Hospital, Peshawar, this study involved 81 patients diagnosed with enteric fever. They were randomly divided into two groups: Group 1 (n=40) received Meropenem alone, and Group 2 (n=41) received a combination of Meropenem and Azithromycin. Key parameters evaluated included gender distribution, age, duration of defervescence, and length of hospital stay. Statistical significance was assessed using appropriate tests. Results: The study found no significant difference in the duration of fever resolution (P=0.571) and hospital stay (P=0.466) between the two groups. The mean defervescence time was 5.325 days for Group 1 and 5.4878 days for Group 2. The average hospital stay was 6.4 days for Group 1 and 6.6098 days for Group 2. Gender distribution and age profile were comparable across both groups. Conclusion: The study concludes that there is no significant difference in the effectiveness of treating enteric fever with Meropenem alone compared to a combination of Meropenem and Azithromycin. This finding supports the use of Meropenem monotherapy as a suitable treatment for enteric fever, potentially reducing treatment protocols and addressing concerns about antibiotic overuse.