COMPARISON OF EFFECTIVENESS OF MEROPENEM VERSUS AZITHROMYCIN IN TREATMENT OF CULTURE POSITIVE SALMONELLOSIS
SUBMISSION DATE: 02/07/25 | ACCEPTANCE DATE: 10/09/25 | PUBLICATION DATE: 25/11/25
Imran ullah1, Inam Ullah khan1, Almas khan1, Moath Ahmed Abdullah Almuradi1, Syed Nouman Ali Shah1, Bilal Ahmad1
1 Khyber Teaching Hospital Peshawar
Corresponding Author: Dr Inam Ullah Khan, Associate Professor, Medicine, Khyber Teaching Hospital
ABSTRACT
Background: Drug resistant enteric fever has reduced reliable treatment options. The Medical Microbiology and Infectious Diseases Society of Pakistan issued 2022 guidance that recommended azithromycin and a carbapenem, but comparative outcome evidence remains limited.
Objective: toCompare mean duration of treatment after meropenem versus azithromycin in culture positive resistant salmonellosis.
Methods: A randomized controlled trial was conducted in the Department of Medicine, Khyber Teaching Hospital, Peshawar, from 8 March 2024 to 7 September 2024. Ninety-six adults aged 20 to 60 years with drug resistant enteric fever were randomized by blocked allocation. Group A received intravenous meropenem 60 mg/kg/day in three divided doses, maximum 1 g per dose. Group B received oral azithromycin 20 mg/kg/day in two divided doses, maximum 1000 mg/day. Standard supportive care included antipyretics and intravenous fluids. Treatment duration was defined as days from starting antibiotics to clinical response. Clinical response was defined as defervescence, measured as time to body temperature below 38°C for more than 48 hours. Mean treatment duration was compared between groups using SPSS version 25.
Results: Mean age was 43.88 ± 10.19 years in the azithromycin group and 40.83 ± 11.24 years in the meropenem group. Men comprised 29 (60.4%) and 23 (47.9%). Typhoid vaccination was reported in 6 (12.5%) and 5 (10.4%). Mean treatment duration was 4.31 ± 1.33 days with azithromycin and 6.77 ± 1.27 days with meropenem, p<0.001.
Conclusion: Azithromycin produced faster fever clearance than meropenem in adults with culture confirmed resistant salmonellosis in this setting.
Keywords: Enteric fever, azithromycin, meropenem, resistant salmonellosis, effectiveness.