{"id":66033,"date":"2026-08-24T10:32:23","date_gmt":"2026-08-24T03:32:23","guid":{"rendered":"https:\/\/www.oucru.org\/?p=66033"},"modified":"2026-08-24T10:32:25","modified_gmt":"2026-08-24T03:32:25","slug":"landmark-south-asian-trial-strengthens-evidence-for-who-recommended-typhoid-treatment","status":"publish","type":"post","link":"https:\/\/www.oucru.org\/id\/landmark-south-asian-trial-strengthens-evidence-for-who-recommended-typhoid-treatment\/","title":{"rendered":"Landmark South Asian trial strengthens evidence for WHO-recommended typhoid treatment\u00a0"},"content":{"rendered":"\n<p>Researchers from OUCRU Nepal and international collaborators have published the results of a landmark clinical trial in <em>The Lancet Infectious Diseases<\/em>, providing important new evidence to guide the treatment of uncomplicated typhoid fever across South Asia. The study, known as<a href=\"https:\/\/www.oucru.org\/project\/act-south-asia\/\"> <strong>ACT-South Asia<\/strong><\/a>,   is the largest trial to evaluate whether combining two commonly used antibiotics, azithromycin and cefixime, offers improved outcomes compared with azithromycin alone.  <\/p>\n\n\n\n<p>Typhoid fever remains a major public health challenge in South Asia, causing millions of infections each year and placing a substantial burden on patients and health systems. While the World Health Organization (WHO) recommends azithromycin for uncomplicated typhoid fever, clinicians often prescribe a combination of azithromycin and cefixime because of concerns about treatment failure and antimicrobial resistance. Until now, there has been limited evidence on whether this combination therapy provides additional clinical benefit.  <\/p>\n\n\n\n<p>To address this question, researchers conducted a double-blind, randomised, placebo-controlled phase 4 trial across 13 hospitals in Nepal, Bangladesh, and Pakistan. Between 2021 and 2025, the study enrolled more than 1,800 participants with suspected or culture-confirmed uncomplicated typhoid fever. Participants received either azithromycin plus cefixime or azithromycin plus placebo for seven days.  <\/p>\n\n\n\n<p>The findings showed that adding cefixime to azithromycin did not reduce treatment failure compared with azithromycin alone. Treatment failure occurred in approximately 5% of participants in both groups, with no significant difference in clinical outcomes. The results provide strong evidence supporting WHO guidance that azithromycin alone remains an effective treatment option for uncomplicated typhoid fever.  <\/p>\n\n\n\n<p><strong>Commenting on the significance of the findings,<a href=\"https:\/\/www.oucru.org\/people\/associate-professor-buddha-basnyat\/\"> Dr Buddha Basnyat<\/a>,  said:<\/strong> <\/p>\n\n\n\n<p><br><em>&#8220;The findings of this randomised controlled trial, published in the most prestigious infectious diseases journal in the world, are, I think, groundbreaking for antibiotic stewardship in the treatment of a very common disease, typhoid fever, which is clearly linked to poverty. Especially because, in all likelihood, the findings are generalisable across South Asia, where a quarter of the world&#8217;s population resides and where typhoid fever and antimicrobial resistance are rampant.&#8221;<\/em> <\/p>\n\n\n\n<p>Importantly, the study also highlights the importance of antimicrobial stewardship. Researchers found no evidence that routine combination therapy improved patient outcomes, suggesting that unnecessary use of cefixime should be avoided. Reducing unnecessary antibiotic use is a critical part of global efforts to slow the emergence and spread of antimicrobial resistance.  <\/p>\n\n\n\n<p>The ACT-South Asia trial demonstrates the power of regional collaboration in addressing infectious diseases that disproportionately affect low- and middle-income countries. Researchers and clinical teams from Nepal, Bangladesh, and Pakistan worked together to generate evidence that is directly relevant to the communities and health systems most affected by typhoid fever.  <\/p>\n\n\n\n<p><a href=\"https:\/\/www.oucru.org\/category\/nepal\/\">OUCRU Nepal<\/a> played a central role in the study through participant recruitment, clinical research activities, laboratory investigations, data collection, and trial implementation. The publication includes contributions from several OUCRU Nepal researchers and collaborators, reflecting the institution&#8217;s long-standing commitment to generating high-quality evidence to improve patient care and public health policy in Nepal and beyond. <\/p>\n\n\n\n<p>This publication further strengthens OUCRU Nepal&#8217;s contribution to globally impactful research and highlights the value of collaborative science in tackling some of the region&#8217;s most pressing infectious disease challenges. <\/p>\n\n\n\n<p>The paper is accessible <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/42624818\/\">here<\/a><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p> <\/p>\n","protected":false},"excerpt":{"rendered":"<p>Researchers from OUCRU Nepal and international collaborators have published the results of a landmark clinical trial in The Lancet Infectious Diseases, providing important new evidence to guide the treatment of [&hellip;]<\/p>\n","protected":false},"author":44,"featured_media":66034,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":"","_links_to":"","_links_to_target":"","_wp_rev_ctl_limit":""},"categories":[79,147],"tags":[],"class_list":["post-66033","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","category-nepal"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.3.1 - 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