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Therapy of multidrug resistant typhoid in 58 children
S H Naqvi1, Z A Bhutta, B J Farooqui
1Department of Pediatrics, Faculty of Health Sciences, Aga Khan University and Hospital, Karachi, Pakistan.
Insights
Treating children with drug-resistant Salmonella typhi infections is challenging. Third-generation cephalosporins like ceftriaxone are effective, but the need for safe, oral Salmonella typhi therapies remains critical.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Resistance
Background:
- Salmonella typhi infections in children pose treatment challenges, especially with multi-drug resistant strains.
- Quinolones are contraindicated in children, limiting oral therapy options for typhoid fever.
Purpose of the Study:
- To evaluate the efficacy of third-generation cephalosporins in treating pediatric Salmonella typhi infections resistant to common oral antimicrobials.
- To compare the effectiveness of ceftriaxone versus cefotaxime in this patient population.
Main Methods:
- Retrospective analysis of 28 children treated with ceftriaxone and 8 with cefotaxime for Salmonella typhi infections.
- Comparison of treatment outcomes, including relapse rates, between the two antibiotic groups.
Main Results:
- Third-generation cephalosporins demonstrated efficacy against Salmonella typhi strains resistant to ampicillin, chloramphenicol, and sulfamethoxazole/trimethoprim.
- Ceftriaxone showed higher effectiveness than cefotaxime, with a significantly lower relapse rate.
- Some patients required altered antibiotic therapy due to poor response or for logistical reasons.
Conclusions:
- Parenteral third-generation cephalosporins are effective for treating drug-resistant Salmonella typhi infections in children.
- Ceftriaxone is a preferred option over cefotaxime due to a lower relapse rate.
- Development of safe and effective oral therapeutic options for pediatric typhoid fever is urgently needed.
Abstract:
Treatment of children with infections caused by Salmonella typhi strains resistant to the commonly used oral antimicrobials is a special problem. As children cannot be treated with quinolones, there is no form of oral therapy. Third generation cephalosporins, which have been shown to be effective against typhoid caused by ampicillin sensitive strains of S. typhi were effective against typhoid caused by ampicillin, chloramphenicol and sulfamethoxazole/trimethoprim-resistant strains. We treated 28 children with ceftriaxone and 8 with cefotaxime. We found ceftriaxone to be more effective than cefotaxime with significantly lower relapse rate. Antibiotic therapy of 19 other children, initially treated in a similar manner, was altered for ease of therapy or due to poor response to therapy. The high cost of this parenteral therapy and the problems in its delivery point to the need for safe, effective oral therapy.