Efficacy of Azithromycin and Meropenem in Pediatric XDR Salmonella Typhi: A Retrospective Study from Abbottabad, Pakistan

Objective: To evaluate the efficacy of azithromycin as a first-line therapy and the combination of meropenem and azithromycin as the second-line therapy in treating pediatric patients with extensively drug-resistant (XDR) Salmonella Typhi in Abbottabad, Pakistan. Methods: This retrospective cross-sectional study was conducted at Department of Pediatrics, Abbottabad International Medical Complex, Pakistan from May 2022 to January 2024. Children aged 1-15 years clinically diagnosed with typhoid fever were enrolled if subsequent blood cultures confirmed XDR Salmonella Typhi infection. Initial treatment comprised azithromycin. If there was no response to azithromycin, patients received a combination therapy of meropenem alongside continued azithromycin. Primary outcomes were clinical recovery, recurrence within 30 days post-treatment, and treatment-related adverse effects. Results: Of total 67 pediatric patients, the mean age of the patients was 10.02 ±2.76 years. The overall mean duration of defervescence was 6.01 ±2.98 days. Initially, all patients were treated with azithromycin alone. Most patients recovered clinically 57 (85.1%). For the 10 (14.9%) who did not respond, meropenem was added to azithromycin, resulting in recovery for all. The mean duration of defervescence found significantly low in patients who received azithromycin monotherapy as compared to patients who received combination therapy i.e., 4.80 ±0.58 days vs. 12.90 ±1.10 days (p-value <0.001). Mild nausea was the only adverse event observed in 29 patients (43.3%) during treatment. Conclusion: Azithromycin monotherapy demonstrated a high clinical recovery rate, with a significant reduction in fever duration compared to combination therapy with meropenem. Mild nausea was the only treatment-related adverse effect observed.