Evidence supporting use of fluoroquinolones as first line agents over other antibiotics for treating typhoid and paratyphoid fever.
Dr Durrane Thaver and colleagues from the United Kingdom compared fluoroquinolones with chloramphenicol, cephalosporins, or azithromycin in culture-proven enteric fever were included.
Data was extracted by 2 reviewers and they assessed methodological quality.
Odds ratios with 95% confidence intervals were estimated.
Trials recruiting over 60% children were analysed separately from trials on adults.
Primary outcomes studied were clinical failure, microbiological failure, and relapse.
The researchers included 20 trials.
Trials were small and often of limited methodological quality.
Only 10 trials concealed allocation and only three were blinded.
|Fluoroquinolones and cefixime were not significantly different|
| British Medical Journal|
The team found in trials on adults, fluoroquinolones were not significantly different from chloramphenicol for clinical failure or microbiological failure but reduced clinical relapse.
Azithromycin and fluoroquinolones were comparable.
Compared with ceftriaxone, fluoroquinolones reduced clinical failure but not microbiological failure or relapse.
Compared with cefixime, fluoroquinolones reduced clinical failure and relapse.
In trials on children infected with nalidixic acid resistant strains, older fluoroquinolones produced more clinical failures than azithromycin.
There were no differences with newer fluoroquinolones.
Fluoroquinolones and cefixime were not significantly different.
Dr Thaver's team concluded, “In adults, fluoroquinolones may be better than chloramphenicol for preventing clinical relapse.”
“Data were limited for other comparisons, particularly for children.”