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Retrospective treatment analysis of Salmonella infections
Y A Gokhale1, G Malkan, L S Bichile
1Lt Municipal Medical College, Sion, Bombay.
Abstract:
Twenty four culture proved and nine postmortem histopathology proved cases of enteric fever were analysed retrospectively with special interest in use of various antisalmonella agents. Chloramphenicol resistance was noted in 91.7% and yet 70% of all patients received chloramphenicol alone or in combination with another antisalmonella agent. Time required for remission of fever with chloramphenical, cotrimoxazole and ciprofloxacin was 4.5, 4.1 and 6.9 days respectively. An interesting feature noted in post-mortem histopathology proved cases was enteric carditis which was documented on postmortem examination of the heart in three out of four patients who died of peripheral circulatory failure.
Insights
High rates of chloramphenicol resistance in enteric fever were observed, yet it was frequently prescribed. Cotrimoxazole showed faster fever remission than chloramphenicol or ciprofloxacin.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Enteric fever remains a significant global health concern.
- Antimicrobial resistance is a growing challenge in treating enteric fever.
- Chloramphenicol has historically been a primary treatment, but resistance is increasing.
Purpose of the Study:
- To analyze the use of various anti-Salmonella agents in culture and histopathology-proven enteric fever cases.
- To evaluate the efficacy of different antimicrobial agents in terms of fever remission time.
- To investigate potential complications like enteric carditis in fatal cases.
Main Methods:
- Retrospective analysis of 24 culture-proven and 9 postmortem histopathology-proven enteric fever cases.
- Assessment of antimicrobial agent usage, focusing on anti-Salmonella drugs.
- Comparison of fever remission duration for chloramphenicol, cotrimoxazole, and ciprofloxacin.
Main Results:
- High chloramphenicol resistance (91.7%) was noted.
- Despite resistance, 70% of patients received chloramphenicol.
- Fever remission times: cotrimoxazole (4.1 days), chloramphenicol (4.5 days), ciprofloxacin (6.9 days).
- Enteric carditis was observed in 3 of 4 postmortem cases with peripheral circulatory failure.
Conclusions:
- Chloramphenicol resistance necessitates a re-evaluation of its use in enteric fever.
- Cotrimoxazole appears to be a more effective agent for fever remission compared to chloramphenicol and ciprofloxacin.
- Enteric carditis is a notable postmortem finding in fatal enteric fever cases.