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Rationale of azithromycin prescribing practices for enteric fever in India

S Rai1, S Jain, K N Prasad

  • 1Department of Microbiology, UCMS and GTB Hospital, Dilshad Garden, Delhi - 110 095, India. sumit_rai@yahoo.com

Indian Journal of Medical Microbiology
|February 25, 2012
PubMed
Abstract

Insights

Salmonella resistance to nalidixic acid is high in North India. Azithromycin shows reduced effectiveness in vitro and in vivo, suggesting cautious use for enteric fever.

Area of Science:

  • Clinical Microbiology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Enteric fever, primarily caused by Salmonella spp., remains a significant public health concern in India.
  • Emerging antimicrobial resistance poses a challenge to effective treatment strategies for Salmonella infections.

Purpose of the Study:

  • To determine the current susceptibility patterns of Salmonella spp. blood isolates in North India against nalidixic acid, ciprofloxacin, and azithromycin.
  • To compare the in vitro and in vivo efficacy of azithromycin in treating Salmonella infections.

Main Methods:

  • Minimum Inhibitory Concentration (MIC) testing was performed on 107 blood isolates of Salmonella spp.
  • In vitro susceptibility to nalidixic acid, ciprofloxacin, and azithromycin was evaluated.
  • Correlation of in vitro findings with in vivo azithromycin response using treatment and discharge summaries from Hospital Information System (HIS) software.

Main Results:

  • A high prevalence of nalidixic acid-resistant (NAR) Salmonella was observed (94%, 87.8%).
  • 36% of isolates exhibited resistance to azithromycin, with an MIC 90 value of 24 μg/mL.
  • Clinical non-response to azithromycin was documented in 33% of patients, necessitating a change in therapy.

Conclusions:

  • The study indicates higher azithromycin MIC 90 values in Indian Salmonella isolates compared to Western studies.
  • Documented clinical non-response highlights potential limitations of azithromycin for enteric fever in this region.
  • A guarded approach to azithromycin use for enteric fever in India is recommended, with a potential resurgence of older antibiotics like chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole.

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