Publication:

Retrospective survey on efficacy of cefixime-ofloxacin 400 milligram sustained release fixed-dose combination tablet for enteric fever in community settings of India

Background The World Health Organization (WHO) estimate for annual global incidence of typhoid fever, about 21 million cases, is probably an underestimate because of poor diagnostics. Multi-drug resistant (MDR) isolates and nalidixic resistant isolates have limited the choice of oral drugs available for the treatment of typhoid fever. Recently the Indian regulatory authority approved an oral fixed dose combination (FDC) of cefixime and ofloxacin for the treatment of typhoid fever.

Methods Retrospective survey was planned to observe the efficacy of cefixime-ofloxacin 400 mg sustained release (SR) FDC tablet for enteric fever in community settings of India. Family physicians involved in the management of enteric fever cases were selected across 4 zones (East, South, West, and North) each by convenient sampling to have uniform representation of population across the country. Each physician was given survey questionnaire booklet containing survey forms.

Results Total 78 family physicians participated in the survey with 881 completed questionnaire forms. Hypertension, diabetes were present in 83% (N=244) patients with comorbid conditions. One hundred and fifty four (17.4%) cases revealed history of relapse or recurrence. Fever clearance rate of 97% was observed in overall evaluable population. Sub analysis in high risk cases (relapse/recurrence) showed equally good response to the combination as cases without defervescence on day 3 and day 7 were only 21.4% and 1.3% respectively.

Conclusions Based on the present study we believe that cefixime-ofloxacin 400mg SR FDC to be an appropriate choice in the management of resistant enteric fever cases, especially in presence of comorbid conditions like hypertension or diabetes which adds to excess pill burden.