Multi-drug-resistantSalmonella typhi—a need for therapeutic reappraisal

Abstract

Enteric fever caused by Salmonella typhi resistant to all the standard first-line antibiotics is emerging as a major problem in developing countries. Fifteen such culture-proven cases were treated with ceftriaxone (6), cefotaxime (5) or ciprofloxacin (4). The earliest defervescence occurred with ceftriaxone (mean 3.3 days). Clinical cures were obtained with all three drugs with only one child having a relapse. Ciprofloxacin, by virtue of its cost and an oral route of administration, is the ideal choice in a developing country.

Laboratory-Based Surveillance of Salmonella Serotype Typhi Infections in the United States

“…Some have suggested that patients with a history of travel to the Indian subcontinent should receive ciprofloxacin as first-line therapy. 14,15 However, Salmonella Typhi strains that are resistant to ciprofloxacin and ceftriaxone have recently been reported, 6,8,[16][17][18][19][20][21] and ciprofloxacin is not approved for use in children, further complicating the choice of antimicrobial therapy for suspected infections.…”

A Study of Typhoid Fever in Bheri Zonal Hospital and Nepalgunj Medical College Teaching Hospital, Banke, Nepal

“…There have been reports of seasonal typhoid outbreaks, recently in 2002 in Bharatpur, a town in Central Nepal which was the largest single-point source outbreak of multidrug-resistant (plasmid encoded single point mutation) typhoid fever associated with contamination of municipality water supply affecting more than 6,000 patients in a 4 to 5 weeks period. 8,[12][13][14]…”