Cefixime-ofloxacin Combination in the Management of Uncomplicated Typhoid Fever in the Indian Community Setting.

Antimicrobial resistance is a global problem and is definitely a cause of concern in India too, in the context of typhoid fever. It is becoming clearer that monotherapy is not effective for typhoid fever and the option to be considered is combination therapy. There are very few antibiotic combinations that are approved and backed by clinical evidence, available in India for the treatment of typhoid fever. Cefixime-ofloxacin combination is approved by Indian Regulatory Authority and has a good body of clinical evidence in the current Indian context. In-silico studies have demonstrated positive rationale of combining these two drugs, while in-vitro studies have substantiated the same by showing a strain specific synergistic and or additive activity between the two drugs against S. typhi. Clinical studies in Indian patients have shown multiple benefits of using this combination in typhoid fever such as a quick time to defervescence (~3 days), complete clinical cure in ~7 days, effective symptomatic relief, efficacy in relapse cases and a reduced need for hospitalization. The drug combination also demonstrates a very good tolerability profile. Recommendations of the Association of physicians of India also back this combination in typhoid fever. Thus, in the current era of emerging antibiotic resistance, cefixime-ofloxacin is a safe, effective and reliable treatment option for clinicians to treat uncomplicated typhoid in the Indian community setting.