Enteric fever in Birmingham: Clinical features, laboratory investigation and comparison of treatment with pivmecillinam and co-trimoxazole
| Autor: | A.M. Geddes, A.P. Ball, C.J. Ellis, A.P. Gillett, I.D. Farrell, P.D. Clarke |
|---|---|
| Rok vydání: | 1979 |
| Předmět: |
Microbiology (medical)
medicine.medical_specialty medicine.drug_class business.industry Sulfamethoxazole digestive oral and skin physiology Antibiotics medicine.disease Trimethoprim Typhoid fever Surgery Pivmecillinam chemistry.chemical_compound Infectious Diseases chemistry Internal medicine medicine Rose spots Headaches medicine.symptom Mecillinam business medicine.drug |
| Zdroj: | Journal of Infection. 1:353-365 |
| ISSN: | 0163-4453 |
| DOI: | 10.1016/s0163-4453(79)90702-3 |
| Popis: | Summary The features of enteric fever have been assessed in 29 patients, predominantly from the Indian sub-continent. The disease presented as a non-specific febrile illness with an insidious, onset. Fever was almost invariable (96 per cent), but relative bradycardia was uncommon (14 per cent) and gastro-intestinal features were absent in over half of the patients. Splenomegaly (34 per cent) and rose spots (10 per cent) were also infrequent. Fever in Asian immigrants, associated with cough in 48 per cent, and with sweating (69 per cent) and rigors (30 per cent) in others may have accounted for the empirical prescription of antibiotics (40 per cent) and antimalarials (30 per cent) by the family practitioner prior to hospital admission. This variable presentation demands a high index of suspicion in febrile recent immigrants and stresses the need for laboratory investigation. The criteria for inclusion have resulted in a high proportion of positive blood cultures in the present series, but stool cultures were also positive in 96 per cent, even in patients in the first week of illness. The Widal reaction was rarely diagnostic but the relevant somatic (0) antibody titres were 1/100 or greater in 83 per cent on admission. Mild anaemia was common but leucopenia was found in only 17 per cent of patients. Twenty-six of the 29 patients were treated with pivmecillinam, 13 receiving parenteral mecillinam initially. The results have been compared with a re-analysis of a previous series of 21 patients treated with co-trimoxazole. Both agents were well tolerated and unwanted effects were few. Eighty-eight per cent of patients responded satisfactorily to pivmecillinam compared with 86 per cent of those receiving co-trimoxazole. Overall relapse rates were also similar (pivmecillinam 12 per cent; co-trimoxazole 14 per cent) but unlike co-trimoxazole, relapses on pivmecillinam occurred during treatment. Stool clearance immediately following pivmecillinam (13 per cent) was markedly lower than with co-trimoxazole (72 per cent) but clearance rates at the time of discharge were similar (co-trimoxazole 83 per cent; pivmecillinam 69 per cent) and only one patient in each group became a long term carrier. |
| Databáze: | OpenAIRE |
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