[spacharya]

I have been following the debate and discussion about Gatifloxacin trail for Enteric fever in Patan, Nepal.
At a face value, the article gives an impression of having a breakthrough in the management of Enteric Fever by this trial. I sincerely hope that this will prove to be far superior to other drugs currently available. However, there are many questions raised in this forum which have not been clarified and satisfactorily answered. Many people have contributed in this forum, but the bulk of discussion seems to be between Dr Anil Tuladhar (UK), and two authors: Dr Basnyat and Dr Pandit. Among others rbineeta (UK) has also raised some interesting points. As I am also working in UK, I would like to emphasize that this debate is not between the authors and some Nepalese doctors in the UK. The issues are not only about the results and outcomes, but they are also about how the trail is conducted. Regarding dysglycemia, I still struggle to understand why the investigators were so happy that they didn’t feel that blood glucose monitoring was warranted in these patients. I feel, although these patients were not diabetic, such an important side effect highlighted in the literature with severe consequences, should have been monitored. The question raised by Dr Pandit regarding one mortality in Cefixime group is already mentioned by rbineeta in the discussion.There are few more authors/investigators in this study, who are actually from UK. One author has much wider association with Vietnam, Oxford, and Manchester and also with Wellcome Trust. It would also be useful to read their views on Gatifloxacin, its safety, the limitations put on their marketing and use in the West. You may also be interested to read the press release by Wellcome Trust on 27 June 2007.
http://www.wellcome.ac.uk/doc_WTX038509.html
Let’s not forget that any drug or intervention carries risk of side effects and complications.
I hope that the decision of using any drug should be based on risk/benefit ratio, efficacy, and availability of particular drugs, and their safety record. I will be only too pleased to see if Gatifloxacin meets these criteria and can save many lives. But we need a robust evidence before we draw any firm conclusions. Finally, I am very pleased that so much of interest has been generated in this scientific discussion and I would like to thank everyone for their contribution in this healthy debate.