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Nepalese researchers have identified a new drug that is more affordable and effective at treating drug-resistant typhoid fever than the drug currently recommended by the World Health Organization (WHO).

The research was published today (27 June) in the open-access journal PLoS ONE.

Typhoid fever is an infection of the digestive system and the blood caused by Salmonella typhi bacteria, which are transmitted to humans by ingesting faeces, most commonly through contaminated water. It is a major problem in Nepal.

Researchers from Patan Hospital, Lalitpur, Nepal and the Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam, compared the currently recommended drug cefixime with gatifloxacin, a new broad-spectrum antibiotic in 390 patients.

Enrolment in the trial was suspended when significant differences were revealed between the two drugs.

They found that gatifloxacin cleared fever more quickly than cefixime — an average of 92 hours versus 138 hours — and had fewer overall treatment failures at 3.5 per cent versus 37.6 per cent.

"We have shown that gatifloxacin may be better than an established drug used by many doctors around the world," said Buddha Basnyat, of Patan Hospital and author of the paper.

There is currently no resistance to gatifloxacin; with the older drug, resistance is becoming a problem. Because of this patients taking longer to recover, suffering more complications and continuing to spread the disease to their family and community.

Gatifloxacin is also cheaper and easier to use than cefixime, at just over US$1 for a seven-day course.

"The present recommended course of treatment [with cefixime] for typhoid fever is 14 days. It is quite expensive for the rural people of Nepal, as they need US$10 to complete a course for treatment of typhoid fever," said Resham Lamichhane, public health inspector from the Nepalese Department of Health Services.

Basnyat said that the drug is not yet available in Nepal, only India, and requested that the Nepalese Department of Drug Administration take notice of the findings.

But Santosh K. C., pharmacist inspector at the Nepalese Drug Information Unit, under the Department of Drug Administration, said the drug registration for gatifloxacin in Nepal is still pending.

Symptoms of typhoid fever include fever, headache, nausea and loss of appetite, sometimes with a cough and constipation or diarrhoea. There are an estimated 22 million cases each year, with 200,000 deaths mostly in developing countries according to the WHO.

Link to full article/paper in PLos ONE

Reference: PLoS ONE doi  10.1371/journal.pone.0000542

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