What Should We Be Recommending for the Treatment of Enteric Fever?
What Should We Be Recommending for the Treatment of Enteric Fever?
复制标题
DOI：
10.1093/ofid/ofad179
复制
发表时间：
2023-05
影响因子：
4.2
通讯作者：
中科院分区：
文献类型：
--
作者：
在流行地区，疑似肠热（伤寒和副伤寒）患者主要作为门诊患者进行治疗。非特异性的临床表现、缺乏准确的诊断工具以及广泛的抗菌药物耐药性使管理面临挑战。所有抗菌药物均已出现耐药性，包括氯霉素、阿莫西林、甲氧苄啶-磺胺甲恶唑、环丙沙星、头孢曲松和阿奇霉素。随机对照试验 (RCT) 的系统评价显示这些抗菌药物治疗肠热病的能力没有显着差异。抗菌药物的选择应以当地耐药模式和国家指导为指导。广泛耐药的伤寒分离株需要用阿奇霉素和/或美罗培南治疗。结合针对细胞内和细胞外伤寒菌的抗菌药物是阿奇霉素和头孢克肟治疗伤寒 (ACT-SA) 随机对照试验 (ACT-SA) 中正在探索的策略，该策略正在南亚进行中。替代抗菌药物，例如口服碳青霉烯类、替比培南，需要临床评估。缺乏证据来指导慢性粪便携带者的抗菌管理。肠热（伤寒和副伤寒）患者的治疗具有挑战性。抗菌药物的选择以当地耐药模式为指导。未来的治疗方案可能需要抗菌药物组合或新药物。指导慢性携带者抗菌治疗的证据有限。
Patients with suspected enteric (typhoid and paratyphoid) fever are predominantly managed as outpatients in endemic regions. Nonspecific clinical presentation, lack of accurate diagnostic tools, and widespread antimicrobial resistance makes management challenging. Resistance has been described for all antimicrobials including chloramphenicol, amoxycillin, trimethoprim-sulfamethoxazole, ciprofloxacin, ceftriaxone, and azithromycin. No significant differences have been demonstrated between these antimicrobials in their ability to treat enteric fever in systematic reviews of randomized controlled trials (RCTs). Antimicrobial choice should be guided by local resistance patterns and national guidance. Extensively drug-resistant typhoid isolates require treatment with azithromycin and/or meropenem. Combining antimicrobials that target intracellular and extracellular typhoid bacteria is a strategy being explored in the Azithromycin and Cefixime in Typhoid Fever (ACT-SA) RCT, in progress in South Asia. Alternative antimicrobials, such as the oral carbapenem, tebipenem, need clinical evaluation. There is a paucity of evidence to guide the antimicrobial management of chronic fecal carriers. Management of patients with enteric (typhoid and paratyphoid) fever is challenging. Antimicrobial choice is guided by local resistance patterns. Future regimens may require antimicrobial combinations or new agents. There is limited evidence to guide the antimicrobial management of chronic carriage.
登录
查看更多内容
DOI：
10.1093/cid/ciaa1773
发表时间：
2021-03-01
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Carey ME;Jain R;Yousuf M;Maes M;Dyson ZA;Thu TNH;Nguyen Thi Nguyen T;Ho Ngoc Dan T;Nhu Pham Nguyen Q;Mahindroo J;Thanh Pham D;Sandha KS;Baker S;Taneja N
通讯作者：
Taneja N
影响因子：
2.9
作者：
Koya, Shaffi Fazaludeen;Farooqui, Habib Hasan;Mehta, Aashna;Selvaraj, Sakthivel;Galea, Sandro
通讯作者：
Galea, Sandro
影响因子：
5.2
作者：
PASCUAL, A;CONEJO, MC;PEREA, EJ
通讯作者：
PEREA, EJ
影响因子：
4.9
作者：
Matsumoto, Y;Ikemoto, A;Matsumo, K
通讯作者：
Matsumo, K
影响因子：
5.7
作者：
Jain, Akash;Utley, Luke;Pucci, Michael J.
通讯作者：
Pucci, Michael J.