الفهرس 
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Abstract
Typhoid Fever Is Still Endemic In Egypt And Represents A Very Important Public Health Problem. This Study Was Conducted To Assess The Clinical And Bacteriological Efficacy Of Oral Cefixime In Seven-Day Course Treatment In Children. Seventy-Four Cases Suspected Clinically To Have Typhoid Fever Were Included In This Study. Widal Test And Blood Culture Were Done For Confirmation. Non-Confirmed Cases Or Lost Cases During Follow Up Were Excluded from The Study. The Final Population For The Study Was Thirty Cases That Were Undertaken To Follow Up And Analysis. All The Study Populations Were Admitted To Fayoum Fever Hospital In The Period Of ”Between March 2013 To August 2016”. Their Age Ranged Between Six Months And Twelve Years With A Mean Of 6.5 ± 4.2 Years. Of Our Cases, 43.3 % Were Female While 56.7% Were Male.
All Cases Were Subjected To A Full Clinical History, Laboratory Investigations, Clinical Examination, Adverse Effects And Tolerability Assessments Which Were Done For All Cases At The Time Of Admission As A Database For Zero Time And Also During Treatment. All Data, Conditions, Clinical Findings And Laboratory Findings Were Recorded In A Hospital Performa And Refilled In Organized Excel Sheets. Informed Consent Was Obtained from The Cases According To The Permission Obtained from The Ethics Committee Of The Faculty Of Medicine In Benisuef University.
After Collecting Samples For The First Time, All Cases Received Oral Cefixime With A Dosage Regimen Of 20 Mg/Kg/Day Divided Into Two Doses As A Dose Every 12 Hrs. Fever Clearance Time, Acute Treatment Cure, Acute Treatment Failure, Relapse, Total Treatment Cure, Safety, And Tolerability Profiles Were Checked As Treatment Indicators Regarding These Parameters To A Seven-Day Course Treatment.
As Regards To Diagnosis Of Typhoid Cases, The Majority Of Cases 43.3% Had O Antigen Widal Test (1/640), And Lowest Percentage 10% Had 1/160 Titer. As Regards To H Antigen, 6.6% Were Negative Results, And 30% Had (1/640), Finally As Regards To Blood Culture All Cases Had Positive Results.
Between The Thirty Cases Of Typhoid Fever All Cases Had Sensitivity To Cefixime, Ceftriaxone And Levofloxacin, Followed By 96.7% Susceptible To Cefotaxime, 73.3% Susceptible To Ciprofloxacin, 63.3% Sensitive To Ofloxacin, With High Resistance To Cotrimoxazole (63.3%) Followed By Ampicillin (53.3%) And Chloramphenicol (43.3%).
Fever Was The Presenting Symptom In All Cases, 70% Of Patients Had Chills. Appetite Loss Was Seen In 83.3% Of Cases. Other Symptoms Were Vomiting (23.3%), Cough (36.7%), Diarrhea (16.7%), Abdominal Pain (46.7%) And Constipation (6.7%). A Rapid Improvement Was Observed With Cefixime Treatment. The Mean Duration Of Clinical Signs And Symptoms Ranged from Two To Four Days Except For Toxic Look With Mean 1.5 Days. The Fever Had The Highest Mean Value Of Duration (3.9±1.4 Days) Among The Clinical Signs Followed By Abdominal Tenderness (3.3±1.3 Days) While Coated Tongue (2.9±0.90 Days), Rose Spots On The Skin (3±0 Days) And Dehydration (2.8±0.84 Days) Had Similar Values. The Toxic Look Had The Lowest Mean’s Duration Value (1.5±0.63 Days).
The Clinical Signs Represented By This Study In order Of Frequency Were Fever (100%), Toxic Look (53%), Coated Tongue (23%), Dehydration (17%), Abdominal Tenderness (13%) And Rose Spots On The Skin (3%). Diarrhea (3±1.5 Days) And Cough (3±1.4 Days) Had The Higher Similar Mean’s Duration Values Followed By Chills (2.7±1.2 Days), Appetite Loss (2.5±1.4 Days), Constipation (2.5±0.7 Days) Then Vomiting (2.1±1.2 Days) But The Abdominal Pain (1.9±1.1days) Had The Lowest Mean Value Of Duration Among Clinical Symptoms.
Body Temperature Profile Included Several Parameters Like Initial Body Temperature At Admission, Duration Of Fever Prior To Admission, Fever Clearance Time (Defervescence Of Temp).
The Duration Of Fever Prior To Admission Ranged from Six Days To Nine Days For Thirteen (43.3%) Cases. Eleven (36.7%) Cases Were Feverish In A Range Between Nine Days To Fourteen Days While The Fever Remained Above Fourteen Days In Six (20%) Cases. Generally, All The Cases Of This Study Remained Feverish Prior To Admission For 11.1 ± 3.6 Days (Mean ± SD).
The Initial Body Temperature Observed At Admission For Eight (27%) Cases Was 38.5 °C, Seven (23%) Cases Was 39°C, Five (17%) Cases Was 38°C, Four (13.3%) Cases Was 39.5 °C, Three (10%) Cases As 40 °C, Two (6.67%) Cases As 40.5 °C While One Case Was Recorded Having 41 °C, So The Majority (67%) Of Our Patients Had A Body Temperature At Admission Ranged from 38.5°C To 39.5°C With A Mean Body Temperature 39.03±0.82°C For All Cases In The Study.
The Fever And Temperature’s Behavior Was Followed Up Daily During Treatment. The Initial Temperature Was (39±0.82 °C) Which Improved Promptly On The First Day To (37.9±0.35 °C). The Improvement Became More Slowly The 2nd Day To (37.6±0.16 °C), Then The 3rd Day To (37.6±0.19 °C) Till Reached The Allowed Values At The 4th Day (37.4±0.27 °C). More Gentle Improvement Occurred Over The Next 3 Days To (37.3±0.30 °C), (37.1±0.26°C) And (37.1±0.20 °C). The Fever Decreased Through The Treatment Course And Reached The Normal Level After Four Days.
Fever Cleared In 10% Of Cases In The Second Day. 40% Of Patients Had No Fever After 3 Days Of Treatment, 76.7% Of Cases Cured After Four Days. Fever Cleared Collectively In 90% Of The Patients After The 5th Day. One Case Cured Daily In The 6th, 7th And 8th Days. So The Day Of Defervescence (Primary Outcome) Of Cefixime In This Study Was (3.9 ± 1.4) Days.
The Laboratory Investigations Were Clarified Before And After Treatment Using (Mean Value ± SD) The Abnormalities Frequency Numbers And Percentages Parameters. Hemoglobin Level Improved from 10.6±1.2 Mg/Dl Before Treatment To 10.9±0.91mg/Dl After Treatment, As Thirteen (43.3%) Cases Were Anemic But Decreased After Treatment To Nine (30%) Anemic Cases. Platelets Count Increased from 194.03±41.1 Before Treatment To 243.6±42.1 After Treatment While Six (20%) Cases Had Thrombocytopenia Before Treatment And Disappeared After Treatment With No Thrombocytopenic Cases. Total Leucocytic Count Increased from 5.9±2.7 Before Treatment To 6.6±1.1 After Treatment. Deeply In The White Blood Cells Differential Count Analysis, Lymphocytes Decreased from 35.1±14.1 Before Therapy To 33.7±4.7 After Therapy, Neutrophils Increased from 60.3±13.3 Before Treatment To 60.9±0.80 After Treatment, Eosinophils Increased from 1.23±1.3 To 2.23±1 Upon Therapy And Monocytes Changed from 3.4±1.4 Before Treatment To 3.2±1.4 After Treatment. Although All Mean Values Mentioned In Differential Leucocytic Count Analysis Were Within The Normal Ranges, Several Abnormalities Were Present Among The Cases. Leucopenia Had Presented In Six (20%) Cases Which Improved To The Normal Values After Treatment While Leukocytosis Was Observed In Two (7%) Cases Before Treatment But Restored To The Normal Values Upon Treatment. Eosinopinea Was The Second Higher Presenting Laboratory Finding But Improved Also from Fourteen (47%) Cases Before Treatment To Three (10%) Cases After Treatment. One Case Represented Eosinophilia Which Restored After Treatment.
Liver Enzymes Abnormalities Were The Highest Among The Laboratory Profile. ALT And AST Had A Significant Improvement from 47.2±18.8 And 52.2±20.9 To 29.5±10.5 And 36.1±15.5. ALT And AST Elevations Were Observed In Seventeen (56.7%) Cases And Nineteen (63.3%) Cases At Admission But Was Reduced To Five (16.7%) And Six (20%) Mildly Elevated Cases By Treatment. Despite The Total Bilirubin Mean Values Were Before (0.73±0.20) And After (0.64±0.11) Therapy Within The Normal Values, Total Bilirubin Was Elevated In Four (13.3%) Cases Before Treatment While All The Cases Improved To The Normal Values After Treatment. A Non-Significant Decrease Was Observed Between The Mean Values Of Creatinine Before (0.76±0.12) And After (0.69±0.08) Treatment While One (3.3%) Case Had Slightly Elevated Creatinine Level And Restored To The Normal Levels Upon Treatment.
Despite The Total Improvement, Three (10%) Cases Were Failed While Twenty-Seven Cases Cured. Then The Failed Cases Increased To Four (13.3%) Cases By One Recurrent Case. At The End Of The Study, 90% Of Patients Were Cured, 3.7% Of Cured Cases Showed Recurrence After Three Weeks, With 86.7% Total Cure Rate.
As Regards To Safety Profile For Treatment, The Majority Of Cases Were Normal Without Any Signs Of Side Effects Except 6.7% Show Moderate Diarrhea, And 3.3% Show Skin Rash.
The Tolerability Profile Of Cefixime Was Evaluated, About 93% Had Between Good And Excellent Tolerability With 50% Excellent, And 43.3% For Good, Only 6.7% Had Poor Tolerability.