A study of culture positive multidrug resistant enteric fever--changing pattern and emerging resistance to ciprofloxacin
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Abstract:
The present prospective study was carried out to observe the changing trends in the clinical pattern and multidrug resistance in typhoid fever. Fever was the main presenting feature. Other associated features were headache, vomiting, diarrhoea, altered sensorium and jaundice. Out of 78 patients, one patient died due to enteric encephalopathy and other due to septicaemia with peripheral circulatory failure. 12 patients responded to chloramphenicol and gentamycin. 51 patients responded to ciprofloxacin, while remaining 9 patients responded to combination of cefotaxime and amikacin. Three patients showed in vitro resistance to ciprofloxacin and two out of these also showed no response in vivo. This study re-emphasises the changing pattern, prolonged course and role of quinolones especially ciprofloxacin in the management of drug resistant typhoid fever, but at the same time indicates that ciprofloxacin is not the drug of choice in all cases of typhoid fever and resistance to it may be seen in some cases, where other drugs have to be used.
Insights
This study observed changing clinical patterns and multidrug resistance in typhoid fever. Ciprofloxacin showed effectiveness, but resistance necessitates alternative treatments for some patients.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Typhoid fever remains a significant global health concern.
- Emerging multidrug resistance in Salmonella Typhi complicates treatment strategies.
Purpose of the Study:
- To investigate evolving clinical presentations of typhoid fever.
- To assess current trends in antimicrobial resistance, particularly to ciprofloxacin.
- To evaluate treatment outcomes with various antimicrobial agents.
Main Methods:
- A prospective study involving 78 patients diagnosed with typhoid fever.
- Clinical data collection on presenting symptoms and disease course.
- In vitro and in vivo assessment of antimicrobial susceptibility and treatment response.
Main Results:
- Fever, headache, vomiting, and diarrhea were common symptoms; altered sensorium and jaundice indicated severe cases.
- Two fatalities occurred due to complications: enteric encephalopathy and septic shock.
- Ciprofloxacin demonstrated high efficacy, with 51 patients responding favorably.
- Chloramphenicol and gentamycin were effective in 12 patients.
- A combination of cefotaxime and amikacin was successful in 9 patients.
- Three patients exhibited in vitro resistance to ciprofloxacin, with two showing no clinical improvement.
Conclusions:
- Typhoid fever presents with changing clinical patterns and prolonged courses.
- Quinolones, specifically ciprofloxacin, play a crucial role in managing drug-resistant typhoid fever.
- Antimicrobial stewardship is essential, as ciprofloxacin resistance can occur, necessitating alternative therapeutic options.