Benefits and risks Topical steroids for treatment of Chronic Suppurative Otitis Media

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8.6 Antibiotic treatment for Typhoid Fever

a Children with typhoid fever should be treated with a luoroquinolone i.e. ciproloxacin, gatiloxacin, oloxacin, and perloxacin as a irst line treatment for 7–10 days. — Ciproloxacin: orally 15 mgkg per dose twice daily for 7–10 days. Strong recommendation; moderate quality evidence b If the response to treatment is poor, consider drug-resistant typhoid and treat with a second line antibiotic like 3rd generation cephalosporins or azithromycin. — Cetriaxone IV: 80 mgkg per day for 5–7 days OR — Azithromycin: 20 mgkg per day for 5–7 days Strong recommendation, moderate quality evidence c Where drug resistance to antibiotics among salmonella isolates is known, follow the national guidelines according to local susceptibility data. Strong recommendation, moderate quality evidence he panel noted that patterns of antimicrobial resistance to salmonella isolates are constantly changing, making continuous surveillance of resistance levels critical for clinicians to keep abreast of treatment options. Currently, nalidixic acid resistance is very common and widespread across many countries and there is increasing resistance to ciproloxacin. his trend in antibiotic resistance to luoroquinolones may have implications on the efectiveness of ciproloxacin in some countries, which may require use of alternative luoroquinolone determined by local susceptibility data. It was also noted that the duration of treatment varied from 7 to15 days in the RCTs studies that were reviewed making it diicult to draw a conclusive decision about duration. However, it was clear that treatment required at least ≥ 7 days of irst line antibiotics.

8.6.1 Evidence and summary of findings

First line antibiotics, including beta-lactams and chloramphenicol, have gradually become less useful with increasing drug resistance. Studies of antibiotic resistance since 1989 in the Indian subcontinent and China have shown that 50–80 of all Salmonella typhi isolates were multidrug resistant MDR [Lee 2000]. he choice of antibiotics for enteric fever has been based on studies of the prevalence of MDR Salmonella typhi and paratyphi. A Cochrane review evaluated luoroquinolone antibiotics for treating enteric fever in children and adults compared with other antibiotics, diferent luoroquinolones, and diferent durations of luoroquinolone treatment [haver, 2008]. he review included 38 trials; 22 had unclear allocation concealment and 34 did not use blinding. Only four trials exclusively included children, seven had both adults and children, and three studied outpatients. here are no conclusive data to make irm recommendations regarding the superiority of luoroquinolones over irst line