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Multidrug resistant typhoid fever: therapeutic considerations
S Mishra1, A K Patwari, V K Anand
1Department of Pediatrics, Lady Hardinge Medical College, New Delhi.
Abstract:
Forty six blood culture positive cases were studied during the current outbreak of multidrug resistant typhoid fever (MRTF). The present outbreak was caused by E1 phage type and organisms were resistant to all commonly used drugs for the treatment of typhoid fever, viz., chloramphenicol (78%), co-trimoxazole (76%) and ampicillin (68%). Treatment failures with chloramphenicol (45.5%) corroborated well with in vitro resistance. No treatment failure was seen with chloramphenicol and ceftriaxone, when these drugs were used in cases infected with sensitive strains. Among the alternative drugs used in cases with in vitro sensitivity, successful clinical response was seen with ceftriaxone (4/4) and cefotaxime (8/9) as compared to cephalexin (3/5) or a combination of cephalexin and furazolidone (9/12).
Insights
This study investigated multidrug-resistant typhoid fever (MRTF) caused by E1 phage type. Ceftriaxone and cefotaxime showed promising results against resistant strains, offering alternatives for treatment.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- An outbreak of multidrug-resistant typhoid fever (MRTF) was identified.
- The causative agent was identified as E1 phage type.
- Organisms exhibited resistance to common typhoid treatments like chloramphenicol, co-trimoxazole, and ampicillin.
Purpose of the Study:
- To analyze the drug resistance patterns of MRTF during the outbreak.
- To evaluate the efficacy of various antimicrobial agents in treating MRTF.
- To identify effective treatment options for multidrug-resistant typhoid fever.
Main Methods:
- Blood cultures from 46 patients with MRTF were analyzed.
- Antimicrobial susceptibility testing was performed for commonly used drugs.
- Clinical outcomes were assessed based on treatment regimens.
Main Results:
- High resistance rates were observed for chloramphenicol (78%), co-trimoxazole (76%), and ampicillin (68%).
- Treatment failures with chloramphenicol (45.5%) correlated with in vitro resistance.
- Ceftriaxone and cefotaxime demonstrated high clinical success rates in sensitive strains.
Conclusions:
- The E1 phage type MRTF outbreak highlights significant antimicrobial resistance challenges.
- Ceftriaxone and cefotaxime are effective alternatives for treating susceptible MRTF infections.
- Treatment strategies must adapt to evolving resistance patterns in typhoid fever.