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Research Article
Tenzin Lhadon
Jigme Dorji Wangchuck National Referral Hospital
Corresponding Author
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Background: Enteric fever (EF) continuous to be a serious health threat in Nepal and children are mostly affected from this systemic illness with gruesome complications if left untreated. Accurate diagnosis and appropriate antimicrobial therapy still remain a challenge here. Though ceftriaxone is used as the drug of choice in hospitalized patients, there are concerns on emerging cephalosporin resistance in adults, though not reported in children yet. The objectives of this study were to assess the defervescence time and outcomes of children hospitalized with EF treated with ceftriaxone.
Methods: This prospective observational study was conducted at Kathmandu tertiary hospital, Nepal for 12 consecutive months. Children (5-16 years) diagnosed with enteric fever using WHO or validated clinical diagnostic criteria were eligible for recruitment. After taking written informed consent, enrolled children were treated as per the institutional treatment protocol with a same brand of ceftriaxone of standard daily dose and duration of 7 days for uncomplicated and 10 days for complicated. Data on defervescence time, treatment outcomes and their clinical and laboratory profile were collected in the predesigned proforma and analyzed.
Results: Of 106 enrolled children, the predominant manifestations were headache (95.3%), loss of appetite (94.3%) and abdominal pain (90.6%). The main laboratory findings were positive Widal test (74%) and thrombocytopenia (50%). Nine children (8.5%) showed blood culture positivity. Salmonella typhi with nalidixic acid resistant strains and Salmonella paratyphi A were isolated (2:1) and were sensitive to ceftriaxone (100%). The defervescence mean time was 3.94 days (± 0.96 SD). Children with positive blood culture had significantly longer defervescence time than those with negative culture (4.56 versus 3.89 days; p=0.04). One child developed complication (pneumonia). No children died or encountered treatment failure. Thrombophlebitis (38.7%) was the only adverse effect of ceftriaxone.
Conclusion: Ceftriaxone of once daily dosing regimen exhibited safe and satisfactory treatment outcomes with approximate four days to defervescence. Ceftriaxone can still be drug of choice for the treatment of EF in hospitalized children. Further studies with a greater number of isolates for the classical clinical profile of EF and cephalosporin susceptibility in children may confirm or refute these findings.
Keywords
enteric fever, children, defervescence, ceftriaxone, clinic-laboratory profile, Nepal
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No competing interests reported.
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CURRENT STATUS: Under Review
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Received 01 Apr, 2021
Reviewer #2 agreed
On 27 Mar, 2021
Reviewer #6 agreed
On 27 Mar, 2021
Reviewer #1 agreed
On 27 Mar, 2021
Reviewer #8 agreed
On 27 Mar, 2021
Reviewer #9 agreed
On 27 Mar, 2021
Reviewer #7 agreed
On 27 Mar, 2021
Reviewers invited
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On 23 Mar, 2021
Editor invited
On 18 Mar, 2021
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On 18 Mar, 2021
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On 13 Mar, 2021
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This preprint is under consideration at BMC Pediatrics. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Tenzin Lhadon
Jigme Dorji Wangchuck National Referral Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 19 Mar, 2021
No community comments so far
Review #1 received
Received 01 Apr, 2021
Reviewer #2 agreed
On 27 Mar, 2021
Reviewer #6 agreed
On 27 Mar, 2021
Reviewer #1 agreed
On 27 Mar, 2021
Reviewer #8 agreed
On 27 Mar, 2021
Reviewer #9 agreed
On 27 Mar, 2021
Reviewer #7 agreed
On 27 Mar, 2021
Reviewers invited
Invitations sent on 23 Mar, 2021
Editor assigned
On 23 Mar, 2021
Editor invited
On 18 Mar, 2021
Submission checks complete
On 18 Mar, 2021
First submitted
On 13 Mar, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pediatrics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Enteric fever (EF) continuous to be a serious health threat in Nepal and children are mostly affected from this systemic illness with gruesome complications if left untreated. Accurate diagnosis and appropriate antimicrobial therapy still remain a challenge here. Though ceftriaxone is used as the drug of choice in hospitalized patients, there are concerns on emerging cephalosporin resistance in adults, though not reported in children yet. The objectives of this study were to assess the defervescence time and outcomes of children hospitalized with EF treated with ceftriaxone.
Methods: This prospective observational study was conducted at Kathmandu tertiary hospital, Nepal for 12 consecutive months. Children (5-16 years) diagnosed with enteric fever using WHO or validated clinical diagnostic criteria were eligible for recruitment. After taking written informed consent, enrolled children were treated as per the institutional treatment protocol with a same brand of ceftriaxone of standard daily dose and duration of 7 days for uncomplicated and 10 days for complicated. Data on defervescence time, treatment outcomes and their clinical and laboratory profile were collected in the predesigned proforma and analyzed.
Results: Of 106 enrolled children, the predominant manifestations were headache (95.3%), loss of appetite (94.3%) and abdominal pain (90.6%). The main laboratory findings were positive Widal test (74%) and thrombocytopenia (50%). Nine children (8.5%) showed blood culture positivity. Salmonella typhi with nalidixic acid resistant strains and Salmonella paratyphi A were isolated (2:1) and were sensitive to ceftriaxone (100%). The defervescence mean time was 3.94 days (± 0.96 SD). Children with positive blood culture had significantly longer defervescence time than those with negative culture (4.56 versus 3.89 days; p=0.04). One child developed complication (pneumonia). No children died or encountered treatment failure. Thrombophlebitis (38.7%) was the only adverse effect of ceftriaxone.
Conclusion: Ceftriaxone of once daily dosing regimen exhibited safe and satisfactory treatment outcomes with approximate four days to defervescence. Ceftriaxone can still be drug of choice for the treatment of EF in hospitalized children. Further studies with a greater number of isolates for the classical clinical profile of EF and cephalosporin susceptibility in children may confirm or refute these findings.
Figure 1
Figure 2
Figure 3
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