Azithromycin vs. chloramphenicol for uncomplicated typhoid fever in children

Main Article Content

Yulia Antolis
Tony Rampengan
Rocky Wilar
Novie Homenta Rampengan


Background The emergence of multiple-drug-resistant
Salmonella typhi strains has made it necessary to evaluate new
agents for the treatment of typhoid fever. Azithromycin has in vitro
activity against many enteric pathogens, including Salmonella spp.
However, there is not enough evidence to compare azithromycin
with first-line antibiotics currently used.
Objective To analyze the efficacy of azithromycin compared
to that of chloramphenicol as a first-line drug in the therapy of
uncomplicated typhoid fever in children.
Methods We conducted a randomized open trial from November
2011 to March 2012 on 60 children aged 2-13 years with
uncomplicated typhoid fever. Subjects were randomly assigned
to receive either azithromycin (10 mg/kgBW /day orally once
daily) or chloramphenicol (100 mg/kgBW/day orally in four
divided doses) for 7 days. Efficacy was measured by recording
clinical cures and fever clearance times. Data was analyzed with
Chi-square and T-tests.
Results All of 30 patients in the azithromycin group and 28
out of the 30 patients in the chloramphenicol group were cured
(P= 0.246). Fever clearance time was shorter in the azithromycin
group (mean 37.9 (SD 32.75) hours, 95%CI 25.67 to 50.13)
than in the chloramphenicol group (mean 49 (SD 45.83) hours,
95%CI 3 1.89 to 66.11).
Conclusions The efficacy of azithromycin is similar to that of
choramphenicol in the treatment of uncomplicated typhoid fever
in children. Azithromycin has shorter fever clearance time and
higher cure rate compared to those of chloramphenicol, although
these results are n ot statistically significant.

Article Details

How to Cite
Antolis Y, Rampengan T, Wilar R, Rampengan N. Azithromycin vs. chloramphenicol for uncomplicated typhoid fever in children. PI [Internet]. 30Jun.2013 [cited 19Nov.2019];53(3):155-. Available from:
Received 2016-08-21
Accepted 2016-08-21
Published 2013-06-30


1. Rampengan TH. Demam tifoid. In: Rampengan TH, editor.
Penyakit infeksi tropik pada anak. 2nd ed. Jakarta: EGC; 2007.
p. 46-64.
2. Crump JA, Mintz ED. Global tr ends in typhoid and
paratyphoid fever. Clin Infect Dis. 2010;50:241-6.
3. Mirza SH, Beeching NJ, Hart CA. Multi-drug resistant
typhoid: a global problem. J Med Microbiol.1996;44:317-9.
4. Effa EE, Bukirwa H. Azithromycin for treating uncomplicated
typhoid and paratyphoid fever (enteric fever). Cochrane
Database Syst Rev. 2008;8:CD006083 .
5. Butler T, Sridhar CB, Daga MK, Pathak K, Pandit RB, Khakhria
R, et al. Treatment of typhoid fever with azithromycin versus
chloramphenicol in a randomized multicentre trial in India.
J Antimicrob Chemother. 1999;44:243-50.
6. Ferrera KP, Bomasang ES. Azithromycin versus first line
antibiotics in the therapeutic management of documented cases of typhoid fever: a meta analysis. Phil J Microbiol Infect
Dis. 2004;33: 163-8.
7. Frenck RW Jr, Nakhla I, Sultan Y, Bassily SB, Girgis YF, David
J, et al. Azithromycin versus ceftriaxone for the treatment of
uncomplicated typhoid fever in children. Clin Infect Dis.
2000;3 l: 1134~.
8. Memon IA, Billoo AG, Memon HI. Cefixime: an oral option
for the treatment of multidrug-resistant enteric fever in
children. South MedJ. 1997;90:1204-7.
9. Parry CM, Ho VA, Phuong le T, Bay PY, Lanh MN, Tung
le T, et al. Randomized controlled comparison of ofloxacin,
azithromycin, and an ofloxacin-azithromycin combination
for treatment of multidrug-resistant and nalidixic acidresistant
typhoid fever. Antimicrob Agents Chemother.
10. Dolecek C, La TIP, Rang NN, Phuong LT, Tuan PQ, Du
DC, et al. A multi-center randomised controlled trial
of gatifloxacin versus azithromycin for the treatment of
uncomplicated typhoid and paratyphoid fever in children
and adults in Vietnam. PLoS One. 2008;3:2188.
11. Tribble D, Girgis N, Habib N, Butler T. Efficacy of azithromycin
for typhoid fever. Clin Infect Dis. 1995;21: 1045- 6.
12. Aggarwal A, Ghosh A, Gomber S, Mitra M, Parikh AO.
Efficacy and safety of azithromycin for uncomplicated typhoid
fever: an open label non-comparative study. Indian Pediatr.
13. Girgis NI, Butler T, Frenck RW, Sultan Y, Brown FM, Tribble
D, et al. Azithromycin versus ciprofloxacin for treatment of
uncomplicated typhoid fever in a randomized trial in egypt
that included patients with multidrug resistance. Antimicrob
Agents Chemother. 1999;6:1441-4.
14. Kumar S, Rizvi M, Berry N. Rising prevalence of entericfever
due to multidrug-resistant Salmonella: an epidemiological
study.J Med Microbiol. 2008;57:1247-50.
15. Hatta M, Ratnawati. Enteric fever in endemic areas of
Indonesia: an increasing problem ofresistance. J Infect Dev
Ctries. 2008;30:279-82.
16. Zaki SA, Karande S. Multidrug-resistant typhoid fever: a
review. J Infect Dev Ctries. 2011 ;5:324-37.
1 7. Retsema J, Girard A, Schelkly W, Manousos M, Anderson M,
Bright G, et al. Spectrum and mode of action of azithromycin
(CP-62, 993), a new 15-membered-ring macrolide with
improved p otency against Gram-negative organisms.
Antimicrob Agents Chemother. 1987;3 1:1939-47.
18. Frenck RW Jr, Mansour A, Nakhla I, Sultan Y, Putnam S,
Wierzba T, et al. Sh ort-course azithromycin for the treatment
of uncomplicated typhoid fever in children and adolescents.
Clin Infect Dis. 2004;38:951-7.