A Randomized Controlled Comparison of Azithromycin and Ofloxacin for Treatment of Multidrug-Resistant or Nalidixic Acid-Resistant Enteric Fever

Chinh, Nguyen Tran; Parry, Christopher M.; Ly, Nguyen Thi; Ha, Huynh Duy; Thong, Mai Xuan; Diep, To Song; Wain, John; White, Nicholas J.; Farrar, Jeremy

doi:10.1128/aac.44.7.1855-1859.2000

Cited by 125 publications

(108 citation statements)

References 25 publications

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“…Venous blood (2 ml) was collected from 380 patients with blood culture positive typhoid fever admitted to one of the three hospitals. The samples and studies have been described previously (Chinh et al 2000;Dunstan et al 2001;Luxemburger et al 2001;Phuong et al 1999;Vinh et al 2004). In addition umbilical cord blood samples from babies born at Huong Vuong Hospital in Ho Chi Minh City were collected.…”

Section: Study Populationsmentioning

confidence: 99%

A TNF region haplotype offers protection from typhoid fever in Vietnamese patients

et al. 2007

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The genomic region surrounding the TNF locus on human chromosome 6 has previously been associated with typhoid fever in Vietnam. We used a haplotypic approach to understand this association further. Eighty single nucleotide polymorphisms (SNPs) spanning a 150 kb region were genotyped in 95 Vietnamese individuals (typhoid case/mother/father trios). A subset of data from 33 SNPs with a minor allele frequency of >4.3% was used to construct haplotypes. Fifteen SNPs, which tagged the 42 constructed haplotypes were selected. The haplotype tagging SNPs (T1-T15) were genotyped in 380 confirmed typhoid cases and 380 Vietnamese ethnically matched controls. Allelic frequencies of seven SNPs (T1, T2, T3, T5, T6, T7, T8) were significantly different between typhoid cases and controls. Logistic regression results support the hypothesis that there is just one signal associated with disease at this locus. Haplotype-based analysis of the tag SNPs provided positive evidence of association with typhoid (posterior probability 0.821). The analysis highlighted a low-risk cluster of haplotypes that each carry the minor allele of T1 or T7, but not both, and otherwise carry the combination of alleles *12122*1111 at T1-T11, further supporting the one associated signal hypothesis. Finally, individuals that carry the typhoid fever protective haplotype *12122*1111 also produce a relatively low TNF-α response to LPS.

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Section: Study Populationsmentioning

confidence: 99%

A TNF region haplotype offers protection from typhoid fever in Vietnamese patients

et al. 2007

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“…However, limited access to reliable clinical microbiology facilities and the ready availability and excessive use of low-cost substandard generics of fluoroquinolone has led to the emergence of fluoroquinolone resistance [13]. Clinical failures and inadequate responses to therapy are documented in patients infected with Salmonella strains with reduced susceptibility to fluoroquinolones (MIC > 0.125 ug/ml) [14][15][16][17]. Point mutations in chromosomal genes (gyrA, gyrB, parC, and parE) resulting in strains with reduced susceptibility as well as plasmid-encoded transferable resistance to fluoroquinolones have been reported from many countries [18][19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Antibiotic resistance among Salmonella enterica serovars Typhi and Paratyphi A in Pakistan (2001-2006)

Hasan

Zafar

Abbas

et al. 2008

J Infect Dev Ctries

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Objectives: To compare antimicrobial resistance in S. Typhi and S. Paratyphi A isolates from Pakistan. Methods: Blood samples were collected through > 175 laboratory collection points in major cities and towns across the country. The study included 3,671 S. Typhi and 1,475 S. Paratyphi A isolates (2001)(2002)(2003)(2004)(2005)(2006). Multidrug resistance (MDR) was defined as resistance to first-line agents co-trimoxazole, chloramphenicol and ampicillin. Results: In total, 79.3% S. Typhi and 59.9% S. Paratyphi A were isolated from patients under 15 years of age. During the study period, the MDR rate increased in S. Typhi (34.2 to 48.5% p<0.001), but decreased in S. Paratyphi A (44.5 to 8.6% p<0.001). Quinolone resistance (MIC>1μg/ml) increased in both S. Typhi (1.6 to 64.1% p<0.001) and S. Paratyphi A (0 to 47% p<0.001). The increase in the proportion of strains showing high level quinolone resistance (MIC >4μg/ml) was greater in S. Paratyphi A when compared to S. Typhi. Resistance to first-line drugs was higher in those <15 years of age whereas quinolone resistance was higher in older patients. Conclusion: Differences between S. Typhi and S. Paratyphi A, in terms of evolution of resistance to first-line agents and to quinolones, are evident in this population. The rapid increase in quinolone resistance in S. Paratyphi A when compared to S. Typhi is concerning and requires further study.

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“…In these studies MICs tend not to exceed 32 mg/L [7,8,9]. The British Society for Antimicrobial Chemotherapy (BSAC) also mentions azithromycin being used in treatment of infections with isolate MICs of less than 16mg/L [10], but falls short of providing any specific guidance for testing.…”

Section: Resultsmentioning

confidence: 99%

In vitro activity of azithromycin in Salmonella isolates from Pakistan

Butt

Sultan

2011

J Infect Dev Ctries

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Introduction: Enteric fever is caused by Salmonella enterica serovars Typhi and Paratyphi A, B and C. It is a significant public health issue in Pakistan, which is exacerbated by a high level of resistance some isolates display to drugs routinely used in treatment. Azithromycin may be a treatment option for such isolates. Methodology: We determined the minimum inhibitory concentrations (MICs) of Salmonella Typhi and Paratyphi isolates against azithromycin in an attempt to gauge its feasibility as a therapeutic option. The MICs were also compared with corresponding disc diffusion zone sizes to see if there was consistency between the two tests. We tested 45 Salmonella enterica isolates using E-tests for MIC detection and azithromycin discs with a concentration of 15µg/ml for disc diffusion testing. Results: Salmonella Typhi, Salmonella Paratyphi A, and Salmonella Paratyphi C isolates demonstrated MICs of 2-12mg/L against azithromycin, suggesting that the antibiotic could be used for therapeutic purposes. For Salmonella Paratyphi B, the MICs were 2-48 mg/L. The higher MIC indicates a need for caution when considering use of azithromycin for Salmonella Paratyphi B infections without first testing for the MIC. There was a close correlation between MICs and zone sizes which was statistically significant. Conclusions: Our results indicate azithromycin is a potential therapeutic option for enteric fever. Standardized laboratory testing methods and interpretation for azithromycin against Salmonella enterica would allow laboratories to report upon this antibiotic with confidence.

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A Randomized Controlled Comparison of Azithromycin and Ofloxacin for Treatment of Multidrug-Resistant or Nalidixic Acid-Resistant Enteric Fever

Cited by 125 publications

References 25 publications

A TNF region haplotype offers protection from typhoid fever in Vietnamese patients

A TNF region haplotype offers protection from typhoid fever in Vietnamese patients

Antibiotic resistance among Salmonella enterica serovars Typhi and Paratyphi A in Pakistan (2001-2006)

In vitro activity of azithromycin in Salmonella isolates from Pakistan

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