Ciprofloxacin Treatment Failure in Typhoid Fever Case, Pakistan

Butt, Tariq M.; Ahmad, Rifat Nadeem; Mahmood, Abid; Zaidi, S. Asif

doi:10.3201/eid0912.030230

Cited by 59 publications

(41 citation statements)

References 8 publications

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“…Sporadic cases of ciprofloxacin treatment failure in typhoid fever have been reported in Europe and, more recently, in Asia [31,12]. The increase of MDR S. Typhi has been attributed to the misuse of drugs, not only in the treatment of typhoid, but also in the treatment of other diseases that may be caused by other organisms.…”

Section: Discussionmentioning

confidence: 99%

Typhoid fever in sub-Saharan Africa: Challenges of diagnosis and management of infections

Kariuki

2008

J Infect Dev Ctries

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Typhoid fever, caused by Salmonella enterica serovar Typhi (S. Typhi), is a disease transmitted by the faecal-oral route. It continues to be a public health problem in many developing countries in sub-Saharan Africa. School-age children, especially those from resource-poor settings with inadequate water and sanitation systems, are disproportionately affected. It is estimated that a total of 400,000 cases occur annually in Africa, an incidence of 50 per 100,000 persons per year. Lack of effective diagnosis often leads to inappropriate treatment and management of these infections. Additionally, the emergence and spread of S. Typhi strains having multiple resistance to nearly all commonly available drugs in most developing countries has been a major challenge to health care systems, reducing the effective treatment options for the disease, increasing treatment costs and increasing the risk of complications and death. Although not much data from sub-Saharan Africa has been published, it seems clear that typhoid is common in Nigeria, Mali, Ethiopia and Kenya. Given the importance of information on disease incidence for targeting control measures, including improved sanitation and water supply, vaccination and assessing impact, priority should be given to strengthening surveillance systems for typhoid fever.

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Section: Discussionmentioning

confidence: 99%

Typhoid fever in sub-Saharan Africa: Challenges of diagnosis and management of infections

Kariuki

2008

J Infect Dev Ctries

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“…Optimal detection of endemic strains with reduced susceptibility to fluoroquinolones, for example, ciprofloxacin MIC ≥ 0.125 or ofloxacin [6], is crucial as this drug is frequently used by family physicians for the management of typhoid. Emergence of strains with reduced susceptibility to fluoroquinolone has led to treatment failure, as previously reported in regional and local studies [7,8)]. The method of screening with nalidixic acid has been validated and reported to be efficient for endogenous isolates and is currently in use by many laboratories in Pakistan [9,10].…”

Section: Introductionmentioning

confidence: 85%

Is nalidixic acid screening still valid for the detection of reduced susceptibility of fluoroquinolone with SalmonellaTyphi?

Irfan

Jabeen

Jilani

et al. 2012

J Infect Dev Ctries

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Introduction: Considering the limitations of screening with nalidixic acid to detect reduced susceptibility to fluoroquinolones of Salmonella enterica serovar Typhi (S.Typhi) strains, we evaluated the use of a 30 µg nalidixic acid disc screening method in Pakistan. Methodology: Non duplicate nalidixic acid susceptible S. Typhi isolates (246) from [2003][2004][2005][2006][2007][2008] were retrieved from the Salmonella strain bank. Minimum inhibitory concentrations of ciprofloxacin for all strains were determined by agar dilution and further rechecked by ciprofloxacin E-tests.E. coli ATCC 25922 was used as the control strain. The MIC data for ciprofloxacin were compared with nalidixic acid disk (30µg) zone diameters. Results: Repeat testing of all S. Typhi isolates with a nalidixic acid (30µg) disk showed 100% susceptibility with an average zone diameter of 26 mm. Agar dilution testing revealed reduced susceptibility to ciprofloxacin, with MICs of 0.125 µg /ml for three (1.2%) isolates only. Zone sizes of strains with higher MICs were significantly lower than the strains with lower MICs (20 versus 26 mm) (p value <0.001). Conclusion: Estimation of fluoroquinolone MICs on every nalidixic acid susceptible S. Typhi strain is not cost effective in our setting; the proportion of strains with high fluoroquinolone MICs was found to be very low. We recommend periodic fluoroquinolone MIC determination to include all isolates with a nalidixic acid borderline zone (size 20-22 mm).

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“…However, a single isolate of Salmonella Typhi and two of Salmonella Paratyphi A were found to be resistant towards Ceftriazone. Increasing rates of resistance to quinolones and decreased susceptibility to fl uoroquinolones, reported in a study 18 might make us consider Chloramphenicol as an alternative drug for the treatment of resistant strains of Salmonella.…”

Section: Discussionmentioning

confidence: 99%

“…17 In recent years many case studies has shown failure in the treatment of enteric fever with isolates susceptible to fl uoroquinolones and resistant to Nalidixic acid. 2,18 Hence routine testing of resistance to Nalidixic acid can serve as a useful screening test for fl uoroquinolones. 18 The increase in the resistivity of the antibiotics like Ciprofl oxacin from 0 % in 2005 to 33.33 % in 2013 might have occurred due to the long-term use of the drugs or the misuse of the drugs by the patients.…”

Section: Discussionmentioning

confidence: 99%

“…2,18 Hence routine testing of resistance to Nalidixic acid can serve as a useful screening test for fl uoroquinolones. 18 The increase in the resistivity of the antibiotics like Ciprofl oxacin from 0 % in 2005 to 33.33 % in 2013 might have occurred due to the long-term use of the drugs or the misuse of the drugs by the patients. Ciprofl oxacin and Gentamicin can be used as empirical antibiotics for the treatment of BSIs.…”

Section: Discussionmentioning

confidence: 99%

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Etiology of bloodstream infection and antibiotic susceptibility pattern of the isolates

et al. 2015

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Background: Bloodstream infection (BSI) is a signifi cant cause of morbidity and mortality. In Nepal, very few studies on BSIs have restricted the understanding of their cause, prevention and treatment. This cross-sectional study was conducted to isolate BSIs causing pathogens and determine their antibiotic susceptibility pattern in patients visiting Kathmandu Model Hospital during December 2012 to May 2013. Materials and Methods: Standard laboratory procedure was used to screen, isolate and identify the bacteria from 1,205 patients. The antibiotic susceptibility pattern (AST) was analyzed by modifi ed Kirby Bauer technique and data were analyzed using SPSS version-16. Results: Out of 1,205 blood samples, 186 (15.4 %) were culture positive. The most common bacteria isolated were: Salmonella spp., Escherichia coli, Klebsiella pneumoniae and CoNS. Gram-negative bacteria were the predominant causes of BSIs. Salmonella Typhi was isolated in 71 % cases of bloodstream infection followed by Salmonella Paratyphi A in 16 %, Escherichia coli in 5.3 % and Klebsiella pneumoniae in 0.5 %. The gram-positive organism responsible for causing BSI was coagulase-negative staphylococcus in 7 % cases. There was no signifi cant association between bacteremia and gender of the patients. During ASTs, Gram-negative bacteria were sensitive to Chloramphenicol with only 0.5 % resistivity. Salmonella Typhi (85.6 % of isolates) showed resistance to Nalidixic acid. Gram-positive bacteria showed 100 % sensitivity towards Chloramphenicol and Gentamicin and were least sensitive to Amoxicillin. Conclusion: Salmonella spp., was major cause of BSIs. Increase in antibiotic resistivity for BSI causing pathogens has necessitated continuous monitoring of the susceptibility of organisms towards antibiotics.

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Ciprofloxacin Treatment Failure in Typhoid Fever Case, Pakistan

Cited by 59 publications

References 8 publications

Typhoid fever in sub-Saharan Africa: Challenges of diagnosis and management of infections

Typhoid fever in sub-Saharan Africa: Challenges of diagnosis and management of infections

Is nalidixic acid screening still valid for the detection of reduced susceptibility of fluoroquinolone with SalmonellaTyphi?

Etiology of bloodstream infection and antibiotic susceptibility pattern of the isolates

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