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Multi-drug-resistant Salmonella typhi--a need for therapeutic reappraisal
S Gulati1, R K Marwaha, D Prakash
1Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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.
Insights
Multidrug-resistant enteric fever is a growing concern. Ciprofloxacin offers a cost-effective oral treatment option for Salmonella typhi infections, proving effective in developing countries.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Emergence of multidrug-resistant Salmonella typhi strains poses a significant challenge in developing nations.
- Standard first-line antibiotics are increasingly ineffective against enteric fever.
- Enteric fever treatment requires effective and accessible therapeutic options.
Purpose of the Study:
- To evaluate the efficacy of ceftriaxone, cefotaxime, and ciprofloxacin in treating culture-proven cases of multidrug-resistant enteric fever.
- To compare the treatment outcomes, including defervescence and relapse rates, of the three antibiotics.
- To identify the most suitable antibiotic for enteric fever management in resource-limited settings.
Main Methods:
- A study involving 15 culture-proven cases of multidrug-resistant enteric fever.
- Patients were treated with either ceftriaxone (6 cases), cefotaxime (5 cases), or ciprofloxacin (4 cases).
- Clinical outcomes, including time to defervescence and relapse, were monitored.
Main Results:
- Earliest defervescence was observed with ceftriaxone (mean 3.3 days).
- Clinical cures were achieved with all three antibiotics.
- Only one case of relapse was reported across all treatment groups.
- Ciprofloxacin demonstrated favorable outcomes with its oral administration and cost-effectiveness.
Conclusions:
- Ceftriaxone, cefotaxime, and ciprofloxacin are effective in treating multidrug-resistant enteric fever.
- Ciprofloxacin is identified as an ideal choice for developing countries due to its oral route and affordability.
- Further research into optimal antibiotic strategies for resistant enteric fever is warranted.