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Chloramphenicol resistant enteric fever
B Chakravorty1, N Jain, B Gupta
1Department of Medicine, Safdarjang Hospital, New Delhi.
Abstract:
In recent times there have been several reports of chloramphenicol resistant enteric fever necessitating the use of other antimicrobial agents. Clinical profile of 15 chloramphenicol resistant patients of enteric fever was studied. Three such patients (20%) responded to chloramphenicol despite in vitro resistance to the drug. Hence chloramphenicol still remains the drug of first choice in enteric fever as a majority (68.4%--26 out of 38) of our bacteriologically proven enteric fever patients were cured by the drug. The remaining 12 cases responded satisfactorily to ciprofloxacin (46.7%), gentamicin (20%), and ofloxacin (13.3%). There was an increased incidence of complications among the 15 drug resistant cases as compared to 23 cases of chloramphenicol sensitive enteric fever observed during the same period.
Insights
Chloramphenicol remains a primary choice for enteric fever, effectively treating most cases despite emerging resistance. Some patients resistant in lab tests still respond to this crucial antibiotic.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Reports indicate increasing chloramphenicol resistance in enteric fever.
- Alternative antimicrobial agents are being explored due to resistance concerns.
Purpose of the Study:
- To evaluate the clinical profile of patients with chloramphenicol-resistant enteric fever.
- To assess the continued efficacy of chloramphenicol and alternative treatments for enteric fever.
Main Methods:
- Clinical data from 15 patients with chloramphenicol-resistant enteric fever were analyzed.
- Treatment outcomes were compared between chloramphenicol-sensitive and resistant cases.
- Efficacy of ciprofloxacin, gentamicin, and ofloxacin was assessed in resistant cases.
Main Results:
- Despite in vitro resistance, 20% of patients responded to chloramphenicol.
- Chloramphenicol achieved a cure rate of 68.4% in the overall study population (38 patients).
- Ciprofloxacin, gentamicin, and ofloxacin showed satisfactory response rates of 46.7%, 20%, and 13.3% respectively in resistant cases.
- Drug-resistant cases exhibited a higher incidence of complications compared to sensitive cases.
Conclusions:
- Chloramphenicol remains a valuable first-line treatment for enteric fever, with a significant overall cure rate.
- Alternative antibiotics like ciprofloxacin, gentamicin, and ofloxacin are effective options for resistant strains.
- Increased complications are associated with drug-resistant enteric fever, highlighting the need for effective treatment strategies.