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Multidrug-resistant Salmonella typhi in Pakistani children: clinical features and treatment
1Department of Pediatrics, University of Florida Health Science Center, Jacksonville, USA.
Insights
Multidrug-resistant Salmonella typhi is a significant threat. This study found that Pakistani children with typhoid fever showed resistance, but ofloxacin and ceftriaxone were effective treatments.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Multidrug-resistant Salmonella typhi poses a growing global health challenge.
- Typhoid fever remains endemic in many regions, particularly affecting children.
- Antibiotic resistance necessitates ongoing surveillance and treatment strategy evaluation.
Purpose of the Study:
- To investigate the prevalence and antibiotic susceptibility patterns of Salmonella typhi in Pakistani children.
- To evaluate the clinical outcomes of multidrug-resistant typhoid fever treated with specific antibiotics.
Main Methods:
- Diagnosis of typhoid fever in 170 children using blood culture or Widal's test.
- Antimicrobial susceptibility testing of Salmonella typhi isolates.
- Clinical data collection on patient demographics, treatment, and complications.
Main Results:
- Salmonella typhi was detected in 170 children, with 79 isolates exhibiting multidrug resistance.
- All multidrug-resistant isolates remained sensitive to ofloxacin, cefotaxime, and ceftriaxone.
- Clinical features did not distinguish resistant from non-resistant S typhi infections. Treatment with ofloxacin or ceftriaxone led to recovery in all cases, including those with complications.
Conclusions:
- Ofloxacin and ceftriaxone are effective therapeutic options for multidrug-resistant Salmonella typhi infections in children.
- Clinical presentation is not a reliable indicator of antibiotic resistance in typhoid fever.
- Continued monitoring of antimicrobial resistance is crucial for effective typhoid fever management.
Abstract:
Multidrug-resistant Salmonella typhi has become a major public health problem. In this study, typhoid fever was diagnosed by isolation of Salmonella typhi from blood or by a positive Widal's reaction in 170 Pakistani children. There were 111 boys (65%) and 59 girls (35%). The average age was 6.2 years; 4 (2%) were less than 1 year old, 78 (46%) were 1 to 5 years old, and 88 (52%) were more than 5 years old. All patients were pretreated with antibiotics. Salmonella typhi was detected by culture in 109 cases (64%), by Widal's test in 84 (49%), and by both in 23 (14%). All 79 isolates that were multidrug resistant were sensitive to ofloxacin, cefotaxime, and ceftriaxone. Clinical features of infections due to resistant S typhi did not differentiate these from other cases of typhoid. Fifty-five infections (70%) due to resistant S typhi were treated with ofloxacin and 24 (30%) with ceftriaxone. Sixteen patients had complications, and all recovered.