Gatifloxacin may be best treatment for drug-resistant typhoid

New research carried out by researchers in Nepal has shown that a new and affordable drug, Gatifloxacin, may be more effective at treating typhoid fever than the drug currently recommended by the World Health Organisation.

The study, funded by the Wellcome Trust, has implications for the treatment of typhoid particularly in areas where drug resistance is a major problem. The results are published today in the open access journal PLoS ONE.

Enteric fever, of which typhoid fever is the most common form, is a major disease affecting the developing world, where sanitary conditions remain poor. The best global estimates are of at least 22 million cases of typhoid fever each year with 200,000 deaths. Drug resistance is becoming a major problem and treatment is becoming increasingly difficult, leading to patients taking longer to recover, suffering more complications and continuing to spread the disease to their family and to their community.

Clinical investigators based at Patan Hospital Lalitpur in Kathmandu, Nepal, and the Oxford University Clinical Research Unit in Vietnam have completed a study to see if they can improve the treatment for patients with typhoid fever. Kathmandu has been termed the typhoid fever capital of the world as a result of this disease remaining so common.

Typhoid fever is a major problem in Nepal and in the developing world and drug-resistant strains are making it even more difficult to tackle," says Dr Buddha Basnyat, senior investigator on the study. "The currently recommended treatment, Cefixime, is relatively expensive and must be administered for a longer duration than is ideal. Clearly there is an urgent need for a treatment that is cost-effective and easy to administer."

The results of the study show that a cost-effective new fluoroquinolone drug, Gatifloxacin, may be a better treatment for enteric fever than Cefixime, which is currently recommended by the World Health Organisation. In addition, Salmonella enterica Typhi and Salmonella enterica serovar Paratyhpi A, the two most common bacteria to cause enteric fever, do not show resistance to Gatifloxacin, unlike for other fluoroquinolones.

"We have shown that Gatifloxacin may be better than an established drug used by many doctors around the world," says Dr Basnyat. "There is currently no resistance to the drug, and at just over US$1 dollar for a seven day treatment course is relatively inexpensive."

"This is an important study with major implications for treating disease widespread in the developing world," says Professor Jeremy Farrar from the Oxford University Clinical Research Unit in Vietnam. "It also shows the major contribution that clinical investigators in Nepal, with the experience and knowledge gained from access to thousands of patients, can help make to improving treatment for our patients and to global health.