High dose corticosteroids have earlier been recommended for treatment of patients with severe typhoid fever including hypotension, CNS involvement and DIC. Studies to reproduce the mortality benefits have not been conducted. The present study was aimed to assess the effect of high dose dexamethasone in typhoid fever with clincal/laboratory evidence of disseminated intravascular coagulation.
Thirty-six patients with culture proven typhoid fever associated with laboratory evidence consistent with disseminated intravascular coagulation (DIC), divided randomly into 2 groups were recruited for the study. The study group in addition to the routine therapy including antibiotics received dexamethasone 3 mg/kg body weight followed by 1mg/kg six hourly for 48 hours whereas placebo supplied in similar vials was administered in the control group. Blood and blood products were allowed as required. The two groups were followed and compared for clinical response and response of the coagulation abnormalities (prothrombin time, APTT, platelets, fibrinogen, fibrin degradation products, protein C, protein S, antithrombin III, euglobin lysis time, factor VIII, IX and thrombin time ) at days 8 and 21.
One patient died in both the groups. Apart from these all patients recovered completely and DIC was reversed in both the groups with equal frequency. At day 21 DIC had reversed in 78.9% of the placebo and 76.47% of the steroid group (p=0.59). Defervescence was slightly faster in the steroid group.
High dose dexamethasone does not alter the reversibility of DIC or clinical outcome in patients with multiresistant typhoid fever.
High dose dexamethasone cannot be recommended as an adjunct to therapy in patients with typhoid fever and DIC.
Parvaiz Koul, No Financial Disclosure Information; No Product/Research Disclosure Information