Preliminary observation on drug resistant cases of typhoid fever

We report here a sudden and marked increase in the occurrence, in a captive population, of typhoid fever cases showing multiple drug resistance. Fifty one cases of typhoid fever were seen from January '90 to June '90 of which 49% showed multiple drug resistance. Comparative figures for resistance in the previous three years were 0% (1987), 5% (1988), 14% (1989). Shared resistance to chloramphenicol, ampicillin, amoxycillin and sensitivity to gentamicin, kanamycin, sisomycin, cephazolin, norfloxacin and ciprofloxacin in most of our cases suggest infection by a common strain with R-factor, mediated resistance. The illness was prolonged and associated with serious complications. Therapy with combination of quinolone derivatives and aminoglycoside antibiotics seemed justified on the basis of the in-vitro tests and clinical response. Efforts to identify the strain and stern public health measures to prevent further development of drug resistant S typhi are urgently indicated.