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A comparison of fluoroquinolones versus other antibiotics for treating enteric fever: meta-analysis.

Thaver, D; Zaidi, AK; Critchley, J; Azmatullah, A; Madni, SA; Bhutta, ZA (2009) A comparison of fluoroquinolones versus other antibiotics for treating enteric fever: meta-analysis. BRITISH MEDICAL JOURNAL, 338 (b1865). ISSN 1756-1833 https://doi.org/10.1136/bmj.b1865
SGUL Authors: Critchley, Julia

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Abstract

OBJECTIVES: To review evidence supporting use of fluoroquinolones as first line agents over other antibiotics for treating typhoid and paratyphoid fever (enteric fever). DESIGN: Meta-analysis of randomised controlled trials. DATA SOURCES: Cochrane Infectious Diseases Group specialised register, CENTRAL (issue 4, 2007), Medline (1966-2007), Embase (1974-2007), LILACS (1982-2007), selected conferences, reference lists, and ongoing trial register (November 2007). Review methods Trials comparing fluoroquinolones with chloramphenicol, cephalosporins, or azithromycin in culture-proven enteric fever were included. Two reviewers extracted data and 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. RESULTS: Twenty trials were included. Trials were small and often of limited methodological quality. Only 10 trials concealed allocation and only three were blinded. In trials on adults, fluoroquinolones were not significantly different from chloramphenicol for clinical failure (594 participants) or microbiological failure (n=378), but reduced clinical relapse (odds ratio 0.14 (95% confidence interval 0.04 to 0.50), n=467, 6 trials). Azithromycin and fluoroquinolones were comparable (n=152, 2 trials). Compared with ceftriaxone, fluoroquinolones reduced clinical failure (0.08 (0.01 to 0.45), n=120, 3 trials) but not microbiological failure or relapse. Compared with cefixime, fluoroquinolones reduced clinical failure (0.05 (0.01 to 0.24), n=238, 2 trials) and relapse (0.18 (0.03 to 0.91), n=218, 2 trials). In trials on children infected with nalidixic acid resistant strains, older fluoroquinolones (ofloxacin) produced more clinical failures than azithromycin (2.67 (1.16 to 6.11), n=125, 1 trial), but there were no differences with newer fluoroquinolones (gatifloxacin, n=285, 1 trial). Fluoroquinolones and cefixime were not significantly different (n=82, 1 trial). CONCLUSIONS: In adults, fluoroquinolones may be better than chloramphenicol for preventing clinical relapse. Data were limited for other comparisons, particularly for children.

Item Type: Article
Additional Information: PubMed ID: 19493939 © Thaver et al 2009. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Adult, Anti-Bacterial Agents, Child, Child, Preschool, Fluoroquinolones, Humans, Infant, Randomized Controlled Trials as Topic, Typhoid Fever, Science & Technology, Life Sciences & Biomedicine, Medicine, General & Internal, General & Internal Medicine, UNCOMPLICATED TYPHOID-FEVER, RANDOMIZED CONTROLLED-TRIAL, RESISTANT SALMONELLA-TYPHI, LEVEL CIPROFLOXACIN RESISTANCE, ANTIMICROBIAL DRUG-RESISTANCE, SEROTYPE PARATYPHI-A, MULTIDRUG-RESISTANT, SEROVAR TYPHI, DECREASED SUSCEPTIBILITY, TREATMENT FAILURE
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: BRITISH MEDICAL JOURNAL
ISSN: 1756-1833
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Dates:
DateEvent
3 June 2009Published
Web of Science ID: WOS:000266726300004
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URI: http://openaccess.sgul.ac.uk/id/eprint/1945
Publisher's version: https://doi.org/10.1136/bmj.b1865

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