A Retrospective Real-World Evidence Study Evaluating the Clinical Effectiveness and Safety of Cefixime in Managing Typhoid Fever in Indian Population

Author(s): Dr. Pratyush Kumar, Dr. Amitrajit Pal, Dr. Dattatray Pawar, Dr. Akhilesh Sharma

Background: Typhoid fever, caused by Salmonella enterica serovar Typhi, remains a significant public health issue in endemic areas like India. Rising multidrug and fluoroquinolone resistance limit treatment options, highlighting the need for effective oral alternatives. Cefixime, a third-generation cephalosporin, is commonly used, but large-scale data on its effectiveness and safety in typhoid treatment are limited.

Methods: This multicenter, retrospective, real-world evidence study analyzed anonymized records of 21,515 patients with clinically and/or microbiologically confirmed typhoid fever treated predominantly with cefixime 200 mg. Data were collected at three time points: baseline (start of therapy), intermediate assessment (7 days), and post-treatment follow-up (day 7–14). Clinical and microbiological cure rates, vital signs, laboratory parameters, and adverse events were assessed. Statistical analysis included Chi-square tests and one-way ANOVA with Tukey’s post-hoc test.

Results: Clinical cure was achieved in 93.5% of patients at EOT and 100% at follow-up (p < 0.001). Microbiological cure increased from 90.7% at EOT to 100% at follow-up (p < 0.001). Vital signs (pulse, BP, temperature, respiratory rate, SpO?) and lab markers (Hb, WBC, CRP, liver enzymes) showed significant improvement across visits (p < 0.0001). Adverse events were minimal, occurring in 0.05% of patients at the end of treatment (EOT) and 0.019% during follow-up. The most commonly observed ADRs were mild gastrointestinal disturbances, such as nausea and diarrhea, with no serious or treatment-limiting events reported.

Conclusion: Cefixime showed strong effectiveness and safety in a large, diverse patient group, reaffirming its role as a reliable oral treatment for typhoid fever in routine settings.