An open, randomized clinical study was carried out to compare the clinical efficacy and safety of pefloxacin with that of chloramphenicol in the treatment of typhoid fever. Sixty hospitalized patients (40 men and 20 women, aged from 17 to 64 years), affected by severe proven typhoid sepsis, were randomly assigned to treatment with pefloxacin at a daily dose of 1,200 mg for 15 days (Group A) or with chloramphenicol at a daily dose of 2 g for 15 days (Group B). The two groups of patients were statistically homogeneous regarding both age and sex and all patients were followed for 30 days after the end of therapy. In Group A all the patients completely recovered from infection and all the isolated strains of Salmonella typhi were eradicated by pefloxacin treatment. In Group B two patients had a relapse, two patients became chronic enteric carriers of S. typhi and only 26 patients recovered from infection with complete eradication of the pathogen. The results indicate that pefloxacin is as active as chloramphenicol in the therapy of typhoid fever and that pefloxacin could be a valid antibacterial agent to be used together with appropriate hygienic measures for an eradication program of typhoid fever in the endemic countries.

Adolescent↗

PubMedDate not supplied

Improving the prognostic value of CD4+ count using IgA and clinical signs in HIV-seropositive i.v. drug users.

A population of 549 HIV-positive intravenous drug users, 140 of whom were women, recruited between June 1985 and June 1991, were studied to determine the usefulness of minor clinical signs and biological parameters in predicting progression to AIDS at different CD4+ levels. Ninety-eight subjects developed AIDS during a median follow-up of 4 years. Oral thrush was predictive of progression to AIDS independently of the CD4+ level at enrollment; seborrheic dermatitis was predictive of disease progression only in those with CD4+ under 500 cells/mm3. Regarding the predictive value of the biologic parameters examined, similar IgA levels among HIV-seropositive intravenous drug users with CD4+ > 500 cells/mm3 and HIV-negative intravenous drug users were observed, while higher median levels were found among HIV-positive participants with CD4+ level under 500 cells/mm3. Among intravenous drug users with CD4+ < 500 cells/mm3, a level of IgA higher than 200 mg/dl at enrollment was predictive of faster progression to AIDS. Among participants with CD4+ [corrected] over 500 cells/mm3, an IgA level above 400 mg/dl was still predictive of faster progression, but the sensitivity tended to be low. These findings suggest that an elevated level of IgA and presence of oral thrush may be important early markers of disease progression in HIV-infected intravenous drug users. Seborrheic dermatitis is also predictive, but only in later stages.

Acquired Immunodeficiency Syndrome↗