TREATMENT OF TYPHOID FEVER WITH ANTIBIOTICS

Today, typhoid fever has become much less conspicuous in many parts of the world, largely because of the expansion of sanitary facilities and organized preventive medicine.Nevertheless, cases continue to occur even in the United States and require adequate therapy.Many of the chemotherapeutic and antibiotic agents possess significant inhibitory action on Salmonella typhosa when tested i n vitro.Despite these laboratory promises, only chloramphenicol has proved of value in the treatment of patients with this disease.'Even some of the antibiotics, which appeared to be more promising than chloramphenicol in laboratory studies, have proved decidedly inferior for the care of patients; viz., penicillin, streptomycin, aureomycin, polymixin, and terramy~in.~-'Despite the obvious benefits of chloramphenicol therapy in typhoid fever, several important problems remain unsolved.These are: (1) relapses of typhoid fever occur in an appreciable proportion of treated patients; ( 2 ) S. typhosa are shed in the feces for variable periods after institution of therapy;(3) when present, the typhoid-carrier state is not permanently benefited by chloramphenicol or other antibiotics; and (4) the two common complications, perforation of and hemorrhage from the intestinal ulcer, continue to occur.At least, the first three of these problems are concerned with the fact that chloramphenicol is primarily bacteriostatic rather than bactericidal, in the human body.This report is concerned with a review of the therapeutic effects of chloramphenicol in typhoid fever, and the limitation of this form of treatment.The incidence of common complications, their management, and possible ancillary therapeutic measures are also discussed.Eject on Toxemia and Febrile Course.The course of the toxemia and pyrexia in typhoid fever is notably variable, but the usual total duration in uncomplicated adult cases, who receive only supportive therapy, ranges between 30 and 40 days.Although toxemia and pyrexmia are not inseparable in untreated or treated cases, they generally go hand in hand during the course of the disease.An analysis of 58 patients, carefully studied by our group5# 8 s and summarized in TABLE 1, reveals that, irrespective of age, severity of illness, or stage of disease, when specific therapy was first instituted, the temperature returned to normal levels in an average of 4.0 days.Numerous investigators have noted the uniform consistency of this three to five day febrile toxic course in some several hundred treated cases.6*6 * 8-12 FIGURE' 1 summarizes the findings in a representative case of typhoid fever treated with chloramphenicol.Incidentally, this patient was a member of the original group in which chloramphenicol was first shown to be efficacious in typhoid fever.This 15-year-old boy was started on therapy on the seventh 1043