Effectiveness of treatment regimens for Typhoid fever in the nalidixic acid-resistant S. typhi (NARST) era in South India

2018 ◽  
Vol 48 (3) ◽  
pp. 182-188 ◽  
Author(s):  
Rini Bandyopadhyay ◽  
Veeraghavan Balaji ◽  
Bijesh Yadav ◽  
Sudha Jasmine ◽  
Sowmya Sathyendra ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Nalidixic Acid ◽  
South India ◽  
Inhibitory Concentration ◽  
Treatment Strategies ◽  
Salmonella Typhi ◽  
Drug Resistant ◽  
Clearance Time ◽  
Treatment Regimens ◽  
Fever Clearance Time

The epidemiology of typhoid fever in South Asia has changed. Multi-drug resistant (MDR) Salmonella typhi ( S. typhi) is now frequently resistant to nalidixic acid and thus labelled NARST. Treatment failure with the use of fluoroquinolones has been widely noted, forcing clinicians to adopt alternative treatment strategies. In this observational study, we looked at various treatment regimens and correlated clinical and microbiological outcomes. In 146 hospitalised adults, the median minimum inhibitory concentration (MIC) for ciprofloxacin was 0.38 µg/mL with a median fever clearance time (FCT) of eight days (range = 2–35 days). Of the regimens used, gatifloxacin and azithromycin had a shorter FCT of six days compared to ceftriaxone (ten days; P < 0.001). Though mortality and relapse in our cohort was low, NARST seemed to correlate with mortality ( P = 0.006). Gatifloxacin or azithromycin clearly emerge as the drugs of choice for treatment of typhoid in South India.

scholarly journals Study on the efficacy of ceftriaxone versus azithromycin for the treatment of uncomplicated enteric fever among the patients admitted in a tertiary level hospital

2021 ◽  
Vol 11 (1) ◽  
pp. 1
Author(s):  
Sougata Mitra ◽  
Masuma Khanam ◽  
M. Iqbal Hossain ◽  
Rukhsana Quadir
Keyword(s):  
Blood Culture ◽  
Physical Examination ◽  
Typhoid Fever ◽  
Clinical Cure ◽  
Enteric Fever ◽  
Salmonella Typhi ◽  
Clearance Time ◽  
Medical College ◽  
Fever Clearance Time ◽  
Culture Positive

Background: Typhoid fever is a severe debilitating and potentially life threating illness. In Bangladesh, typhoid fever is a round the year problem which sometimes take epidemic proportions. The reasons behind such occurrences are unsafe water supply, defective sewage system and unhygienic food handling practice. This study aimed to compare the efficacy of ceftriaxone and azithromycin in the treatment of uncomplicated enteric fever.Methods: An observational study was conducted at the department of pharmacology in Dhaka medical college, Dhaka, Bangladesh. Data were collected from blood culture positive patients for Salmonella typhi and Salmonella paratyphi, who admitted in the Dhaka medical college and hospital, Dhaka during the period of July 2015 to June 2016. Data was collected by using a structured questioner, face to face interview, physical examination and investigation reports. Patients were hospitalized during the entire treatment period and at admission evaluation was made by history and physical examination in a structured format. Subjects ware asked regarding changes in symptoms and possible adverse effects of the study drugs. All patients were asked to return two weeks after completion of treatment for follow up. Blood culture of Salmonella typhi or Salmonella paratyphi were done in all cases. Total 91 patients were culture positive for either S. typhi or S. paratyphi which were finally studied.Results: During the study period out of 91 patients, 51 were receiving ceftriaxone and 40 were receiving azithromycin. Clinical cure was achieved in 46 patients (90%) of ceftriaxone group and in 31 patients (78%) in the azithromycin group. There were no significant differences of clinical cure between both treatment groups (p>0.05). Mean fever clearance time in ceftriaxone group was 3±1.4 days and was 4±1.6 days for azithromycin group. Difference in fever clearance time was statistically significant (p<0.05). No clinical relapses were detected in any study subject. No major side effects of both drugs occurred in any subject.Conclusions: These results indicated that both ceftriaxone and azithromycin were effective against enteric fever caused by sensitive organisms and multi drug resistant S. typhi and S. paratyphi. It is concluded that ceftriaxone is more effective and can be a convenient alternative for the treatment of enteric fever, especially in developing countries like us where medical resources are scarce.

scholarly journals High Level of Resistance to nalidixic acid in Salmonella enterica serovar Typhi in Central India

2009 ◽  
Vol 3 (06) ◽  
pp. 467-469 ◽  
Author(s):  
Yashwant Kumar ◽  
Anshu Sharma ◽  
Kavaratty Raju Mani
Keyword(s):  
Minimum Inhibitory Concentration ◽  
Nalidixic Acid ◽  
Inhibitory Concentration ◽  
Treatment Strategies ◽  
Indirect Evidence ◽  
Acid Resistance ◽  
Central India ◽  
Salmonella Typhi ◽  
Delayed Response ◽  
High Level

Background: Fluoroquinolones are the drugs of choice for the treatment of typhoid fever. But the recent increase in minimum inhibitory concentration (MIC) values of ciprofloxacin in Salmonella Typhi may result in delayed response and serious complications. Nalidixic acid resistance has been used as an indirect evidence of increased minimum inhibitory concentration for ciprofloxacin in Salmonella Typhi. Methods: We evaluated the isolates received at the National Salmonella and Escherichia Centre for nalidixic acid and ciprofloxacin susceptibility using standard methods. Minimum inhibitory concentrations have also been evaluated. Results: Ninety-six percent of the isolates were found to be nalidixic acid resistant while all isolates were found to be ciprofloxacin sensitive. The difference between minimum inhibitory concentration values of ciprofloxacin for nalidixic acid resistant and nalidixic acid sensitive isolates was found to be statistically significant. Conclusion: The study may be helpful in revising treatment strategies for the infections caused by nalidixic acid resistant Salmonella Typhi in the country.

Prevalence of Multi-Drug Resistant Salmonella typhi among Clinically Diagnosed Typhoid Fever Patients in Lagos, Nigeria

2000 ◽  
Vol 55 (5-6) ◽  
pp. 489-493 ◽  
Author(s):  
Kabir’ O. Akinyemi ◽  
Akintoye O. Coker ◽  
Daniel K. Olukoya ◽  
Akeeb O. Oyefolu ◽  
Eriwu P. Amorighoye ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Nalidixic Acid ◽  
Susceptibility Testing ◽  
Salmonella Typhi ◽  
Drug Resistant ◽  
First Line ◽  
Isolation Rate ◽  
Total Blood ◽  
Health Institutions ◽  
Group 1

A total of 635 clinically diagnosed typhoid fever patients were bled from three different health institutions in the metropolis of Lagos, Nigeria over a period of 15 months, May 1997 to July 1998. Out of the total blood cultured, 101 (15.9% ) isolates of Salmonella species were isolated of which 68 (67.3% ) were S. typhi, 17 (16.8% ) and 16 (15.8% ) were S. paratyphi A and S. arizonae respectively. The overall isolation rate of S. typhi among patients is 10.7% , with most isolates 45.9% found among the severely-ill young adults, age group 1 6 -30 years. All isolates were subjected to anti-microbial susceptibility testing using 12 different antibiotics: chloramphenicol, ampicillin, cotrimoxazole, gentamicin, colistin sulfate, nalidixic acid, nitrofurantoin, cefotaxime, tetracycline, streptomycin, ofloxacin and ciprofloxacin. All the S. typhi and S. paratyphi A isolates showed resistance to two or more of the 10 of 12 antibiotics tested particularly the 3-first-line antibiotics commonly used (chloramphenicol, ampicillin and cotrim oxazole) in the treatment of typhoid fever in Nigeria. No isolate showed resistance to ofloxacin and ciprofloxacin, however, nalidixic acid and gentamicin showed a moderate and appreciable inhibition to most of our isolates.

scholarly journals Drug-Resistant Salmonella typhi in Pakistan

2019 ◽  
Vol 59 (1) ◽  
pp. 31-33 ◽  
Author(s):  
Christine E. Petrin ◽  
Russell W. Steele ◽  
Elizabeth A. Margolis ◽  
Justin M. Rabon ◽  
Holly Martin ◽  
...  
Keyword(s):  
United States ◽  
Typhoid Fever ◽  
Enteric Fever ◽  
The United States ◽  
Salmonella Typhi ◽  
Antimicrobial Treatment ◽  
Third Generation ◽  
Drug Resistant ◽  
Oral Transmission ◽  
Third Generation Cephalosporins

Enteric fever (formerly typhoid fever) is a bacterial illness caused by fecal-oral transmission of Salmonella typhi or paratyphi. In early 2018, an outbreak of Salmonella typhi resistant to third-generation cephalosporins, ampicillin, ciprofloxacin, trimethroprim-sulfamethoxazole, and chloramphenicol was reported in Pakistan. This strain, termed “extensively resistant typhi,” has infected more than 5000 patients in endemic areas of South Asia, as well as travelers to and from these areas, including 5 cases in the United States. We present the case of one such child who developed extensively resistant enteric fever during a recent visit to Pakistan and required broader antimicrobial treatment than typically required. Clinicians should be aware that incoming cases of enteric fever may be nonsusceptible to commonly recommended antibiotics and that extensively resistant typhi requires treatment with carbapenems such as meropenem or azithromycin.

scholarly journals Comparison of the efficacy of artemether-lumefantrine vs. artesunate plus sulfadoxine-pyrimethamine in children with uncomplicated falciparum malaria

2010 ◽  
Vol 50 (2) ◽  
pp. 113 ◽  
Author(s):  
Rachmawati Rachmawati ◽  
Novie H Rampengan ◽  
Suryadi N N Tatura ◽  
Tonny H Rampengan
Keyword(s):  
Parasite Clearance ◽  
World Health ◽  
Drug Resistant ◽  
Limited Information ◽  
Clearance Time ◽  
Cure Rate ◽  
Fever Clearance Time ◽  
Significant Difference ◽  
Health Organization

Background World Health Organization (WHO) has recommendedthat countries with drug resistant malaria problem usecombination therapies, especially artemisinin-based combinationtherapy (ACT). However, there is limited information on theefficacy of ACT in North Sulawesi.Objective To compare the efficacy of artemether-lumefanttine andartesunate plus sulfadoxine-pyrimethamine (SP).Methods This was a randomized experimental study, conducted inProf. Dr. R. D. Kandou General Hospital, Manado from Januaryuntil July 2009. There were 42 patients aged less than 13 yearstreated with artemether-lumefanttine and artesunate plus SP. Bodytemperature, parasite and gametocyte count were recorded everyday until day 7 and follow-up reviews were done on day 14 and28.Results Fever clearance time showed a significant differencebetween artemether-lumefanttine group (median 27 hours) andartesunate plus SP group (median 18 hours), P<0.05). There wasno significant difference in parasite clearance time (P>0.05) andgame tocyte clearance time (P > 0. 05) . The 28 day cure rate were100% in the two groups. No side effect was found.Conclusion Both artemether-lumefanttine and artesunate plus SPcombination are effective and safe for the treatment of falciparummalaria in children.

scholarly journals Identification of a Novel Therapeutic Target against XDR Salmonella Typhi H58 Using Genomics Driven Approach Followed Up by Natural Products Virtual Screening

2021 ◽  
Vol 9 (12) ◽  
pp. 2512
Author(s):  
Khurshid Jalal ◽  
Kanwal Khan ◽  
Muhammad Hassam ◽  
Muhammad Naseer Abbas ◽  
Reaz Uddin ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Drug Targets ◽  
Salmonella Typhi ◽  
Drug Resistant ◽  
Acid Biosynthesis ◽  
New Drug ◽  
Subtractive Genomics ◽  
Colanic Acid ◽  
Novel Drug ◽  
Potential Drug Targets

Typhoid fever is caused by a pathogenic, rod-shaped, flagellated, and Gram-negative bacterium known as Salmonella Typhi. It features a polysaccharide capsule that acts as a virulence factor and deceives the host immune system by protecting phagocytosis. Typhoid fever remains a major health concern in low and middle-income countries, with an estimated death rate of ~200,000 per annum. However, the situation is exacerbated by the emergence of the extensively drug-resistant (XDR) strain designated as H58 of S. Typhi. The emergence of the XDR strain is alarming, and it poses serious threats to public health due to the failure of the current therapeutic regimen. A relatively newer computational method called subtractive genomics analyses has been widely applied to discover novel and new drug targets against pathogens, particularly drug-resistant ones. The method involves the gradual reduction of the complete proteome of the pathogen, leading to few potential and novel drug targets. Thus, in the current study, a subtractive genomics approach was applied against the Salmonella XDR strain to identify potential drug targets. The current study predicted four prioritized proteins (i.e., Colanic acid biosynthesis acetyltransferase wcaB, Shikimate dehydrogenase aroE, multidrug efflux RND transporter permease subunit MdtC, and pantothenate synthetase panC) as potential drug targets. Though few of the prioritized proteins are treated in the literature as the established drug targets against other pathogenic bacteria, these drug targets are identified here for the first time against S. Typhi (i.e., S. Typhi XDR). The current study aimed at drawing attention to new drug targets against S. Typhi that remain largely unexplored. One of the prioritized drug targets, i.e., Colanic acid biosynthesis acetyltransferase, was predicted as a unique, new drug target against S. Typhi XDR. Therefore, the Colanic acid was further explored using structure-based techniques. Additionally, ~1000 natural compounds were docked with Colanic acid biosynthesis acetyltransferase, resulting in the prediction of seven compounds as potential lead candidates against the S. Typhi XDR strain. The ADMET properties and binding energies via the docking program of these seven compounds characterized them as novel drug candidates. They may potentially be used for the development of future drugs in the treatment of Typhoid fever.

scholarly journals 165. Emergence of Extensively Drug-Resistant Salmonella enterica Serotype Typhi Infections—United States, 2008–2020

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S99-S100
Author(s):  
Felicita Medalla ◽  
Louise Francois Watkins ◽  
Michael Hughes ◽  
Meseret Birhane ◽  
Layne Dorough ◽  
...  
Keyword(s):  
United States ◽  
Typhoid Fever ◽  
The United States ◽  
Empiric Therapy ◽  
Salmonella Typhi ◽  
International Travel ◽  
Drug Resistant ◽  
Extensively Drug Resistant ◽  
Large Outbreak ◽  
Control And Prevention

Abstract Background Typhoid fever, caused by Salmonella Typhi, is fatal in 12%–30% of patients not treated with appropriate antibiotics. In 2016, a large outbreak of extensively drug-resistant (XDR) Typhi infections began in Pakistan with cases reported globally, including the United States. In 2021, the Centers for Disease Control and Prevention (CDC) issued a health advisory on XDR infections among U.S. residents without international travel. We describe resistance of Typhi infections diagnosed in the United States to help guide treatment decisions. Methods Typhoid fever is a nationally notifiable disease. Health departments report cases to CDC through the National Typhoid and Paratyphoid Fever Surveillance system. Isolates are submitted to the National Antimicrobial Resistance Monitoring System for antimicrobial susceptibility testing (AST) using broth microdilution. AST results are categorized by Clinical and Laboratory Standards Institute criteria. We defined XDR as resistant to ceftriaxone, ampicillin, chloramphenicol, and co-trimoxazole, and nonsusceptible to ciprofloxacin. Results During 2008–2019, of 4,637 Typhi isolates, 52 (1%) were ceftriaxone resistant (axo-R); 71% were ciprofloxacin nonsusceptible, 1 azithromycin resistant (azm-R), and none meropenem resistant. XDR was first detected in 2018, in 2% of 474 isolates and increased to 7% of 535 in 2019. Of the 52 axo-R isolates, 46 were XDR, of which 45 were from travelers to Pakistan, and one from a non-traveler; 6 were not XDR, of which 4 were linked to travel to Iraq. In preliminary 2020 reports, 23 isolates were XDR; 14 were from travelers to Pakistan, 8 from non-travelers, and 1 from someone with unknown travel status. Among those with XDR infection, median age was 11 years (range 1–62), 54% were female, and 62% were from 6 states. Conclusion Ceftriaxone-resistant Typhi infections, mostly XDR, are increasing. Clinicians should ask patients with suspected Typhi infections about travel and adjust treatment based on susceptibility results. Carbapenem, azithromycin, or both may be considered for empiric therapy of typhoid fever among travelers to Pakistan or Iraq and in uncommon instances when persons report no international travel. Ceftriaxone is an empiric therapy option for travelers to countries other than Pakistan and Iraq. Disclosures All Authors: No reported disclosures

scholarly journals Randomized Controlled Comparison of Ofloxacin, Azithromycin, and an Ofloxacin-Azithromycin Combination for Treatment of Multidrug-Resistant and Nalidixic Acid-Resistant Typhoid Fever

2006 ◽  
Vol 51 (3) ◽  
pp. 819-825 ◽  
Author(s):  
Christopher M. Parry ◽  
Vo Anh Ho ◽  
Le Thi Phuong ◽  
Phan Van Be Bay ◽  
Mai Ngoc Lanh ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Nalidixic Acid ◽  
Salmonella Enterica ◽  
Clinical Cure Rate ◽  
Controlled Trial ◽  
Multidrug Resistant ◽  
Cure Rate ◽  
Randomized Controlled ◽  
Fever Clearance Time ◽  
The Mean

ABSTRACT Isolates of Salmonella enterica serovar Typhi that are multidrug resistant (MDR, resistant to chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) and have reduced susceptibility to fluoroquinolones (nalidixic acid resistant, Nar) are common in Asia. The optimum treatment for infections caused by such isolates is not established. This study compared different antimicrobial regimens for the treatment of MDR/Nar typhoid fever. Vietnamese children and adults with uncomplicated typhoid fever were entered into an open randomized controlled trial. Ofloxacin (20 mg/kg of body weight/day for 7 days), azithromycin (10 mg/kg/day for 7 days), and ofloxacin (15 mg/kg/day for 7 days) combined with azithromycin (10 mg/kg/day for the first 3 days) were compared. Of the 241 enrolled patients, 187 were eligible for analysis (186 S. enterica serovar Typhi, 1 Salmonella enterica serovar Paratyphi A). Eighty-seven percent (163/187) of the patients were children; of the S. enterica serovar Typhi isolates, 88% (165/187) were MDR and 93% (173/187) were Nar. The clinical cure rate was 64% (40/63) with ofloxacin, 76% (47/62) with ofloxacin-azithromycin, and 82% (51/62) with azithromycin (P = 0.053). The mean (95% confidence interval [CI]) fever clearance time for patients treated with azithromycin (5.8 days [5.1 to 6.5 days]) was shorter than that for patients treated with ofloxacin-azithromycin (7.1 days [6.2 to 8.1 days]) and ofloxacin (8.2 days [7.2 to 9.2 days]) (P < 0.001). Positive fecal carriage immediately posttreatment was detected in 19.4% (12/62) of patients treated with ofloxacin, 6.5% (4/62) of those treated with the combination, and 1.6% (1/62) of those treated with azithromycin (P = 0.006). Both antibiotics were well tolerated. Uncomplicated typhoid fever due to isolates of MDR S. enterica serovar Typhi with reduced susceptibility to fluoroquinolones (Nar) can be successfully treated with a 7-day course of azithromycin.

scholarly journals X-DR (Drug Resistant) typhoid fever in children.

2020 ◽  
Vol 27 (09) ◽  
pp. 1947-1951
Author(s):  
Muhammad Sohail ◽  
Jaweeria Masood ◽  
Jawaria Khalid ◽  
Zahid Mahmood Anjum ◽  
Iram Iqbal ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Significant Proportion ◽  
Antibiotic Sensitivity ◽  
Salmonella Typhi ◽  
Blood Cultures ◽  
Drug Resistant ◽  
Female Ratio ◽  
Sensitivity Pattern ◽  
Zones Of Inhibition ◽  
Culture Positive

Objectives: To study antibiotic sensitivity pattern of Salmonella typhi in children with enteric fever. Study Design: Prospective, Consecutive sampling. Setting: Children Hospital and Institute of Child Health, Faisalabad. Period: 6 Months June 2019 to November 2019. Material & Methods: All admitted children of age 1-16 years with strong clinical suspicion of typhoid fever and with no comorbidities were included in this study. Blood cultures and other relevant investigations were performed to rule out other causes of fever. After identification of organism as Salmonella typhi, antibiotics susceptibility testing was done by disk diffusion technique and zones of inhibition were interpreted according to clinical and Lab standard (CLSI) guidelines. Results: Out of 60 patients maximum children were < 5 year and >10 year of age. Maximum cases were admitted during July to September. Male to female ratio was 1.6:1. We were able to send blood cultures of 31 cases (51%) only. Out of them 14 cases (45%) were found culture positive. All culture positive (100%) were found sensitive to meropenem. 92.8% were found sensitive to azithromycin and 7.1% were found sensitive to amikacin. Overall 16 cases treated with meropenem, 10 cases (16%) with azithromycin and one with amikacin. However, 33 cases (55%) responded to ceftriaxone alone. Conclusion: Sensitivity pattern of Salmonella typhi revealed significant proportion of multidrug and extensive drug resistant strain. So, continue surveillance is needed in this regard to find actual burden of XDR typhoid fever. We recommend local district administration and health authorities to launch an awareness campaign regarding sanitation, good hygiene, use of safe of water and mass vaccination of children with conjugated vaccine against typhoid. Alongwith above measures antibiotic stewardship should be started.

scholarly journals Heading towards threat of resistant super bug…. current pattern of antimicrobial sensitivity to salmonella typhi in Karachi.

2020 ◽  
Vol 27 (05) ◽  
pp. 1070-1073
Author(s):  
Syed Tahseen Akhtar ◽  
Iftikhar Haider Naqvi ◽  
Owais Khan ◽  
Syed Tauqeer Ahmed Hasmi ◽  
Saiyeda Nayema Zehra Rizvi
Keyword(s):  
Typhoid Fever ◽  
Demographic Data ◽  
Treatment Options ◽  
Antibiotic Sensitivity ◽  
Salmonella Typhi ◽  
Multidrug Resistant ◽  
Drug Resistant ◽  
Continuous Variables ◽  
Antimicrobial Sensitivity ◽  
Study Setting

Objectives: The present study was aimed to find out the prevalence of MDR and XDR Typhoid and the remaining or alternate treatment options here in Karachi. Study Design: Descriptive retrospective analytical study. Setting: Department of Medicine, at Mamji Hospital Karachi. Period: From Jan 2019 till July 2019. Material & Methods: The medical records of all the patient admitted, were reviewed by the department of Medicine, at Mamjee Hospital Karachi specifically diagnosed to have Typhoid fever during the period between Jan 2019 till July 2019. A total of 72 patients were included in this study. Chart reviews were used to obtain and later collect the data. Typhoid was confirmed over Blood culture yielding Salmonella typhi. Demographic data and pattern of antibiotic sensitivity were collected. Statistical analysis was performed on SPSS version 17. Continuous variables were expressed as mean ± SD. Discrete variables were expressed as percentages and proportions. Results: From January 2019 till July 2019, 72 patients were diagnosed to have Typhoid fever (Salmonella Typhi culture positive) of which 43(60%) were male and majority of the patients were aged between 18 to 40 years 37(51%). Out of 14 antibiotics checked for sensitivity to Salmonella Typhi the Quinolones were the most resistant (85%) antibiotics followed by Ampicillin (83%) and Trimethoprim-sulfamethoxazole (82%). 48(66%) among 72 patients had extended drug resistant typhoid, 14(19%) were multidrug resistant typhoid while 11(15%) were pan sensitive. Conclusion: Majority of the patients had extended drug resistant typhoid, whereas quite a few had multidrug resistant typhoid. Most sensitive drugs were Imipenem, meropenem and Azithromycin whereas Quinolones along with other agents were found to have most resistance against Salmonella Typhi.

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