Typhoid is like an old enemy that has been around and we underestimate the problems caused by this disease. About 24 million people are affected by this disease on an annual basis, and around 400, 000 succumb to this illness. And guess where most of the illness is seen? In the Indian subcontinent. In the Western world the people that generally are afflicted with typhoid fever are citizens from the West that travel to the Indian subcontinent. Only a minority of patients from the West suffer from these diseases without a travel history. Amongst these travellers there is a especial group called VFRs which stands for visiting friends and relatives.
This group comprises of people, for example Indian origin who live in the US and do not take hygienic precautions when they return to India for a visit. Treatment of typhoid fever is an important topic for us, and the rest of the article discusses this.
In the latest online issue of the Lancet Infectious Disease, our team from Patan Hospital working together with Oxford University published an important article based on the findings of a randomized controlled trial of two drugs in typhoid fever. Typhoid fever which is spread by fecal oral transmission is rampant in the developing world, and there is an ongoing problem with drug resistance. This study was thelargest clinical trial ( 844 patients were recruited over a period of 3 years) on typhoid fever to date.
Appropriate dosage of Gatifloxacin wasadministered for seven days in a once day dosing for patients suspected to have typhoid fever. Gatifloxacin in the study was compared with the oldest drug used in the treatment of typhoid fever, chloramphenicol. There was no difference in the efficacy of these two drugs in the time taken( four days) to bring the fever down.However, unlike cholramhenicol which needs to be taken four times per day for fourteen days, gatifloxacin needs to be taken only once a day for seven days. Clearly most people will favour taking a drug once a day for 7 days rather than four times a day for fourteen days. Our conclusion was that gatifloxacin should be the preferred drug in the treatment of typhoid fever in the developing world.
Gatifloxacinattracted attention several years ago when in an elderly ( > 75 years of age) Canadian population, who were administered the drug for an infection, it was shown to increase or decrease the blood glucose, thus causing some patients to have symptoms of diabetes or low blood sugar ( hypoglycaemia). As a result in North America, this drug was removed from the market. However in our Nepal study the average age of our patients was sixteen, and unlike the elderly Canadian population our patients did not have any co morbidities ( that is, accompanying medical problems like kidney disease). Furthermore we tracked the blood sugar very closely in our population cohort; and there was no obvious blood sugar problem as noted in the elderly Canadian population.
This story of Gatifloxacin is a good example of how a useful and affordable drug should not be discarded just because it is found to have side effects in a completely different patient population in another part of the world. Indeed we are running out of antibiotics to treat life threatening infections like typhoid fever in tropical countries.