PRADEEP KAFLE

In the latest online issue of the Lancet Infectious Disease, our team from Patan Hospital working together with Oxford University published an article based on the findings of a randomised controlled trial of two drugs in typhoid fever.

Typhoid, 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 the largest clinical trial ( 844 patients were recruited over a period of three years) on typhoid fever to date.

Appropriate dosage of Gatifloxacin was administered 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 14 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 seven days rather than four times a day for 14 days. Our conclusion was that gatifloxacin should be the preferred drug in the treatment of typhoid fever in the developing world.

Gatifloxacin attracted attention several years ago when in an elderly 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 16, 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.