Trimethoprim-Sulphamethoxazole in Enteric Infections

Abstract

During the period December 1969 to February 1972, 49 patients with salmonella infections and 54 patients with shigella infections were treated with trimethoprim–sulphamethoxazole (Tri–Su). Eight patients with enteric fever caused by S. typhi and S. paratyphi B were all cured with defervescence after 4.2 days (mean), whereas one patient with S. paratyphi A failed to respond to the treatment. Five out of 13 carriers of various salmonellae were cleared from their carriership in association with the treatment 19 patients from an epidemic of S. enteritidis infection were treated; 58% still excreted salmonellae after 6 weeks. 29 patients of the epidemic received symptomatic treatment only; 41% were excreters after 6 weeks. Tri–Su treatment shortened the period of shigella excretion significantly in two controlled studies. In 31 treated cases of sporadic shigella infections (Sh. sonnei and Sh. flexneri) the average time for excretion was 10.7 days, compared to 26.3 days in 10 untreated cases. In an epidemic of Sh. sonnei infection comprising 20 cases, 10 patients treated with Tri–Su had negative stool cultures 2.8 days (mean) from the start of the therapy, while the corresponding figure for 10 untreated patients was 22.6 days (mean). 29 strains of Sh. sonnei and Sh. flexneri showed full sensitivity to trimethoprim. Tri–Su treatment should only be given in strictly selected cases.