SYNTHETIC AND FERMENTATION TYPE CHLORAMPHENICOL (CHLOROMYCETIN) IN TYPHOID FEVER: PREVENTION OF RELAPSES BY ADEQUATE TREATMENT

Abstract

A continuation of the studies on the use of chloramphenicol (Chloromycetin) in the treatment of patients with typhoid fever indicates that the synthetic form of the drug is as efficacious as the natural antibiotic obtained by the fermentation process from Streptomyces venezuelae. The same total amts. of either type drug are equally effective when given in divided doses at 2-6 hr. intervals or in larger doses once or twice daily. There was a definite relationship between the duration of chloramphenicol treatment and the occurrence of relapses in typhoid fever. Slightly more than half of the patients who were treated for 8 days or less had a recrudescence of the disease, which began about 10 days after treatment was stopped. No relapses occurred in the groups of patients treated for longer periods of time. The present data suggest that a 14-day period of treatment is sufficient to prevent relapses. In spite of the dramatic therapeutic effectiveness in patients with typhoid fever, complications such as intestinal hemorrhage and perforation may be expected in treated patients, since the stage is generally set for such developments before therapy is instituted and time is required for the healing of the typhoidal lesion of the intestine. In the present group of 23 patients, 2 had hemorrhage sufficiently severe to produce shock. In addition, 2 other patients suffered intestinal perforation; the course in 1 of these was further complicated by severe hemorrhage and the disease terminated fatally. Neither of the patients with perforation was given surgical treatment; chloramphenicol therapy controlled or suppressed the usual signs of generalized peritonitis. On the basis of the present observations, it would appear that the adequate treatment of typhoid fever in the adult consists of an initial oral dose of 3-4 g. of chloramphenicol, followed by 1.5 g. oral doses given every 12 hrs. during the febrile period and by single daily 1.5 g. doses for 7 days; thereafter the dose may be reduced to a single 1 g. dose and continued until the 14th day of antibiotic therapy, after which the drug may be discontinued. Particular attention should be given to the recognition of intestinal perforation in treated patients, since the classical signs of this development with the ensuing generalized peritonitis may be partially masked by the antibacterial effect of chloramphenicol.