COMPARISON OF SINGLE VERSUS COMBINATION DRUG THERAPY IN EXTENSIVELY DRUG RESISTANT SALMONELLA TYPHI IN TERMS OF TIME TO DEFERVESCENCE

This randomized controlled trial will compare the effectiveness of single-drug therapy (meropenem) versus combination therapy (meropenem plus azithromycin) in children aged 2-16 years diagnosed with extensively drug-resistant (XDR) typhoid fever at the Children's Hospital, Lahore. A total of 94 patients will be enrolled and randomly assigned to either treatment group. The primary outcome is time to defervescence, defined as sustained resolution of fever for more than 48 hours. Secondary outcomes include duration of hospital stay and complication rates. The study aims to provide evidence to guide optimal management of XDR typhoid in pediatric populations."

* Inclusion Criteria 1. Children aged 2-16 years 2. Culture-confirmed XDR typhoid fever (resistant to first-line agents, fluoroquinolones, and third-generation cephalosporins) 3. Admitted to Children's Hospital \& Institute of Child Health, Lahore Informed consent obtained from parent/guardian Exclusion Criteria 1. Age \16 years 2. Known allergy or contraindication to meropenem or azithromycin 3. Presence of severe comorbidities (e.g., congenital heart disease, chronic renal failure, immunodeficiency) 4. Patients already receiving carbapenem or azithromycin therapy prior to enrollment