Typhoid fever in travelers: Time for reassessment.

Enteric fever (EF) is the most common bacteremic disease affecting travelers to the tropics. For more than a decade, fluoroquinolones have been considered the drugs of choice for EF. However, recent reports have raised concern about fluoroquinolone resistance. Treatment with ciprofloxacin failed in a traveler with Salmonella paratyphi EF who had recently returned from India. Treatment failed despite minimum inhibitory concentrations of fluoroquinolones within the susceptible range. Further in vitro investigations revealed very low serum bactericidal activity with ciprofloxacin. Clinicians should be aware of the recent changes in the interpretation of Salmonellae sensitivity.