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Ceftriaxone therapy in ciprofloxacin treatment failure typhoid fever in children

P Dutta1, U Mitra, S Dutta

  • 1Divisions of Clinical Medicine & Microbiology, National Institute of Cholera & Enteric Diseases (ICMR), Kolkata, India.

The Indian Journal of Medical Research
|January 31, 2002
PubMed
Abstract

Insights

Multidrug-resistant typhoid fever poses treatment challenges. Ceftriaxone effectively treated children unresponsive to ciprofloxacin, indicating it as a reliable alternative for MDR typhoid.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Pediatrics

Background:

  • Multidrug-resistant (MDR) typhoid fever is a growing global health concern.
  • Ciprofloxacin is often the preferred treatment for typhoid, even in children, following resistance to chloramphenicol.
  • This study addresses treatment failures with ciprofloxacin in MDR typhoid cases.

Purpose of the Study:

  • To evaluate the efficacy of ceftriaxone in children with MDR typhoid fever who did not respond to ciprofloxacin.
  • To investigate the in vitro susceptibility of Salmonella typhi strains to chloramphenicol, ciprofloxacin, and ceftriaxone.

Main Methods:

  • 140 children (3-10 years) with typhoid fever unresponsive to 12-14 days of ciprofloxacin were enrolled.
  • Blood cultures confirmed Salmonella typhi in 32 patients.
  • Positive cases were treated with intravenous ceftriaxone for 14 days, and isolated strains underwent antimicrobial susceptibility testing.

Main Results:

  • All 32 bacteriologically confirmed patients achieved clinical and bacteriological cure with ceftriaxone.
  • 100% of isolated Salmonella typhi strains were susceptible to ciprofloxacin and ceftriaxone in vitro.
  • 50% of strains exhibited resistance to chloramphenicol, with MICs ranging from 125-500 µg/ml.

Conclusions:

  • Despite in vitro susceptibility, ciprofloxacin failed clinically and bacteriologically in MDR typhoid patients.
  • Ciprofloxacin may not be a reliable option for treating MDR typhoid fever.
  • Ceftriaxone demonstrated effectiveness as an alternative treatment for MDR typhoid cases.

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