We compared high-dose dexamethasone (initial dose, 3 mg per kilogram of body weight) with placebo in a randomized, double-blind trial involving 38 patients with culture-positive, specifically defined severe typhoid fever. The patients in the two treatment groups ranged in age from 5 to 54 and were comparable at the outset. All patients received chloramphenicol. The case-fatality rate of 10 per cent (2 of 20 patients) in the dexamethasone group was significantly lower than the fatality rate of 55.6 per cent (10 of 18) in the placebo group (P = 0.003). There was no significant difference in the incidence of complications among the survivors in either group. Delirium, obtundation, and stupor were grave prognostic signs that were useful for predicting which patients were at high risk of dying before they became comatose or went into shock. Dexamethasone is unnecessary for most patients with typhoid but is recommended for all patients with suspected typhoid fever who are delirious, obtunded, stuporous, comatose, or in shock.
This article has been cited by other articles:
Hosoglu, S., Ustun, C., Geyik, M. F.
(2009). The efficacy of dexamethasone treatment in massive enteric bleeding in typhoid fever. Trop Doct
39: 53-54
[Full Text]
McGee, S., Hirschmann, J.
(2008). Use of Corticosteroids in Treating Infectious Diseases. Arch Intern Med
168: 1034-1046
[Abstract][Full Text]
Baker, S., Holt, K., van de Vosse, E., Roumagnac, P., Whitehead, S., King, E., Ewels, P., Keniry, A., Weill, F.-X., Lightfoot, D., van Dissel, J. T., Sanderson, K. E., Farrar, J., Achtman, M., Deloukas, P., Dougan, G.
(2008). High-Throughput Genotyping of Salmonella enterica Serovar Typhi Allowing Geographical Assignment of Haplotypes and Pathotypes within an Urban District of Jakarta, Indonesia. J. Clin. Microbiol.
46: 1741-1746
[Abstract][Full Text]
Basnyat, B.
(2007). The treatment of enteric fever. JRSM
100: 161-162
[Full Text]
Pandit, A., Arjyal, A., Farrar, J., Basnyat, B.
(2006). Nepal. PN
6: 129-133
[Full Text]
Vincent, J.-L., Abraham, E.
(2006). The Last 100 Years of Sepsis. Am. J. Respir. Crit. Care Med.
173: 256-263
[Abstract][Full Text]
Meduri, G.U., Carratu, P., Freire, A.X.
(2003). Evidence of biological efficacy for prolonged glucocorticoid treatment in patients with unresolving ARDS. Eur Respir J
22: 57s-64s
[Abstract][Full Text]
van Doorn, K. J., Pierard, D., Verbeelen, D., Basnyat, B., Zaidi, A. K.M., Hasan, R., Bhutta, Z. A., Parry, C. M., Hien, T. T., White, N. J., Farrar, J. J.
(2003). Typhoid Fever. NEJM
348: 1182-1184
[Full Text]
Parry, C. M., Hien, T. T., Dougan, G., White, N. J., Farrar, J. J.
(2002). Typhoid Fever. NEJM
347: 1770-1782
[Full Text]
Coursin, D. B., Wood, K. E.
(2002). Corticosteroid Supplementation for Adrenal Insufficiency. JAMA
287: 236-240
[Full Text]
Atkins, B. L., Gottlieb, T., Licciardone, J., Gleckman, R., Zenilman, J. M.
(1998). Emerging Drug Resistance and Vaccination for Typhoid Fever. JAMA
279: 579-580
[Full Text]
Lamberts, S. W.J., Bruining, H. A., de Jong, F. H.
(1997). Corticosteroid Therapy in Severe Illness. NEJM
337: 1285-1292
[Full Text]
Pan, M., Wasa, M., Ryan, U., Souba, W.
(1996). Lipopolysaccharide and Tumor Necrosis Factor Stimulate Lung Microvascular Arginine Uptake, a Response Attenuated by Dexamethasone. JPEN J Parenter Enteral Nutr
20: 50-55
[Abstract]
Heppner, D. G., Magill, A. J., Gasser, R. A., Oster, C. N.
(1993). The Threat of Infectious Diseases in Somalia. NEJM
328: 1061-1068
[Full Text]
Kovacs, J. A., Masur, H.
(1990). Are Corticosteroids Beneficial as Adjunctive Therapy for Pneumocystis Pneumonia in AIDS?. ANN INTERN MED
113: 1-3
[Abstract]
Thisyakorn, U., Mansuwan, P., Taylor, D. N.
(1987). Typhoid and Paratyphoid Fever in 192 Hospitalized Children in Thailand. Arch Pediatr Adolesc Med
141: 862-865
[Abstract]
Previous
