In 1970, Chawla et al were concerned about the “rampant use” of chloramphenicol for treatment of typhoid fever owing to its serious toxic effects. They studied hetacillin (a synthetic derivative of 6-aminopenicillinic acid) as a safer alternative and concluded that it had comparable efficacy with fewer side effects.
Fifty years later, typhoid fever remains a public health problem, especially in developing countries, causing approximately 11 to 21 million cases and 128 000 to 161 000 deaths annually, with the peak incidence in children aged 5 to <15 years. Up to the 1970s, chloramphenicol was widely used to treat enteric fever. It was replaced by ampicillin and trimethoprim-sulfamethoxazole due to the emergence of resistant strains. In the early 1980s, there was a rapid emergence of IncHI1 plasmid-mediated resistance to all 3 drugs, in multidrug-resistant strains. This prompted the use of fluoroquinolones, which were highly efficacious.
Click here to read the article, published in The Journal of Pediatrics.