Treatment of enteric fever

Enteric fever is systemic illness caused by Salmonella Typhi and Salmonella Paratyphi A, B and C. It is believed to be a readily treatable illness by many clinicians in the developing world where it is endemic; however, with the emergence of drug resistance to fluoroquinolones, treatment is becoming increasingly difficult. While drugs such as cefixime, previously believed to be effective, have been proven otherwise, new agents such as gatifloxacin and azithromycin have proven to be promising. Re-emergence of chloramphenicol sensitive strains in previously resistant areas points towards the concept of antibiotic recycling, preserving the use of older antibiotics. Antibiotic recycling has been used successfully in hospital settings. However, its usefulness in community settings, where the main burden of enteric fever resides, is challenging to manage due to logistics and a lack of infrastructure. Nalidixic acid resistance used to be a marker for clinical response to flouroquinolones; however, recent studies highlight the importance of decreased ciprofloxacin susceptibility as a better marker. Enteric fever, as a public health problem, has been tackled by protection of food and water supplies in the industrialised countries of the world. Nonetheless, that goal seems too far-fetched in the developing world where there are hundreds of villages, towns and cities without adequate infrastructures. Perhaps the key to solving this problem is combining point-of-use-purification of water (by chlorination) with the treatment of illness in the community. Treatment of chronic carriers is also necessary in order to halt the cycles of transmission.