BACKGROUND & OBJECTIVES: The rapid spread of multidrug resistant (MDR) typhoid fever has posed a great challenge for the treatment of these cases the world over. After the emergence of chloramphenicol resistant Salmonella typhi strains, ciprofloxacin has become the drug of choice for the treatment of typhoid fever even in the paediatric age group. This study evaluated the role of ceftriaxone therapy in bacteriologically confirmed MDR typhoid cases who did not respond to 12-14 days of ciprofloxacin therapy. Attempts have also been made to investigate the in vitro susceptibility of isolated S. typhi strains to chloramphenicol, ciprofloxacin and ceftriaxone. METHODS: A total of 140 children, aged 3-10 yr, clinically diagnosed as having typhoid fever, without any clinical response after 12-14 days of ciprofloxacin therapy were screened for S. typhi by blood culture. In the bacteriologically positive children the treatment was changed to intravenous ceftriaxone for 14 days. The isolated strains of S. typhi were tested for in vitro antimicrobial susceptibility. RESULTS: Clinical and bacteriological cure was observed with intravenous ceftriaxone therapy in all the 32 bacteriologically positive patients. All isolated S. typhi strains were uniformly (100%) susceptible to ciprofloxacin and ceftriaxone but 50 per cent of the strains were resistant to chloramphenicol. The MIC values of chloramphenicol, ciprofloxacin and ceftriaxone ranged between 125-500, 0.0625-0.5 and < 0.0625 microgram/ml respectively. INTERPRETATION & CONCLUSION: The study indicates that although the S. typhi strains were susceptible to ciprofloxacin in vitro, the patients did not respond clinically and bacteriologically to ciprofloxacin therapy. Hence, ciprofloxacin may not represent a reliable and useful option for treating MDR typhoid fever; ceftriaxone may be an effective alternative for the treatment of such cases.
BACKGROUND & OBJECTIVES: The rapid spread of multidrug resistant (MDR) typhoid fever has posed a great challenge for the treatment of these cases the world over. After the emergence of chloramphenicol resistant Salmonella typhi strains, ciprofloxacin has become the drug of choice for the treatment of typhoid fever even in the paediatric age group. This study evaluated the role of ceftriaxone therapy in bacteriologically confirmed MDR typhoid cases who did not respond to 12-14 days of ciprofloxacin therapy. Attempts have also been made to investigate the in vitro susceptibility of isolated S. typhi strains to chloramphenicol, ciprofloxacin and ceftriaxone. METHODS: A total of 140 children, aged 3-10 yr, clinically diagnosed as having typhoid fever, without any clinical response after 12-14 days of ciprofloxacin therapy were screened for S. typhi by blood culture. In the bacteriologically positive children the treatment was changed to intravenous ceftriaxone for 14 days. The isolated strains of S. typhi were tested for in vitro antimicrobial susceptibility. RESULTS: Clinical and bacteriological cure was observed with intravenous ceftriaxone therapy in all the 32 bacteriologically positive patients. All isolated S. typhi strains were uniformly (100%) susceptible to ciprofloxacin and ceftriaxone but 50 per cent of the strains were resistant to chloramphenicol. The MIC values of chloramphenicol, ciprofloxacin and ceftriaxone ranged between 125-500, 0.0625-0.5 and < 0.0625 microgram/ml respectively. INTERPRETATION & CONCLUSION: The study indicates that although the S. typhi strains were susceptible to ciprofloxacin in vitro, the patients did not respond clinically and bacteriologically to ciprofloxacin therapy. Hence, ciprofloxacin may not represent a reliable and useful option for treating MDR typhoid fever; ceftriaxone may be an effective alternative for the treatment of such cases.
Authors: Christopher M Parry; Vo Anh Ho; Le Thi Phuong; Phan Van Be Bay; Mai Ngoc Lanh; Le Thanh Tung; Nguyen Thi Hong Tham; John Wain; Tran Tinh Hien; Jeremy J Farrar Journal: Antimicrob Agents Chemother Date: 2006-12-04 Impact factor: 5.191
Authors: Christopher M Parry; Chau Tran Thuy; Sabina Dongol; Abhilasha Karkey; Ha Vinh; Nguyen Tran Chinh; Pham Thanh Duy; Tran Vu Thieu Nga; James I Campbell; Nguyen Van Minh Hoang; Amit Arjyal; Zulfiqar A Bhutta; Sujit K Bhattacharya; Magdarina D Agtini; Baiqing Dong; Do Gia Canh; Aliya Naheed; John Wain; Tran Tinh Hien; Buddha Basnyat; Leon Ochiai; John Clemens; Jeremy J Farrar; Christiane Dolecek; Stephen Baker Journal: Antimicrob Agents Chemother Date: 2010-09-13 Impact factor: 5.191
Authors: Trupti A Patel; Margaret Armstrong; Stephen D Morris-Jones; Stephen G Wright; Tom Doherty Journal: Am J Trop Med Hyg Date: 2010-06 Impact factor: 2.345
Authors: Christopher M Parry; Ha Vinh; Nguyen Tran Chinh; John Wain; James I Campbell; Tran Tinh Hien; Jeremy J Farrar; Stephen Baker Journal: PLoS Negl Trop Dis Date: 2011-06-21