I appreciate the keen interest shown by the reader in our article titled “Current trends in the management of typhoid fever” published in MJAFI 2003;59(2):130-5. Our clarification to the observations made by the reader are as under:
(a) Recommendations regarding use of vaccinations including Typhoral Oral Vaccine (Ty 21a) are constantly revised based on experience gathered with ongoing use of the vaccine. “S typhi 21a strain in an enteric coated capsule has given a 67% protection rate in Chili lasting for 3 years after 3 doses given on alternate days. A four dose schedule which appears to better protect is preferred in the USA. On the other hand one recent trial in Indonesia had found the vaccine to confer 47% efficacy” [1]. It is advisable to look up latest guidelines for vaccines as article sent for publication comes up for print after a period of 1-2 years when recommendations may have changed.
(b) Most standard text books of Medicine and Pharmacology continue to mention dose of Quinolones as absolute values and not in per Kg body weight. This may be due to low MIC 90, compared to high serum levels achieved by most Quinolones [1, 2, 3, 4]. Only recently per Kg recommendations have been issued for treatment of Anthrax.
References
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