Fluoroquinolones in the treatment of typhoid fever and the carrier state

Abstract

Typhoid fever remains an important public health problem throughout the world with a higher morbidity and mortality rate in the developing countries. Early establishment of the diagnosis and prompt initiation of treatment with chloramphenicol, ampicillin or trimethoprim-sulfamethoxazole is not necessarily followed by complete resolution of the infection. Between 1% and 6% of patients with typhoid fever become chronic biliary carriers of Salmonella typhi. These carriers are potential factors in the continued transmission of the disease. The increasing emergence worldwide of strains showing multiple resistance to the agents traditionally used in therapy has encouraged investigators to seek alternatives such as third generation cephalosporins and recently the new 4-quinolones, which have greater activity against Salmonella typhi including multi-resistant strains. The fluoroquinolones seem to be the treatment of choice in those regions where resistant strains of Salmonella typhi are prevalent.

Bacterial Biofilm and its Role in the Pathogenesis of Disease

“…Using the murine gallstones model Gonzales et al showed that S. Typhimurium was more resistant to antibiotic treatment in mice fed a cholelithiasis-inducing diet compared to mice fed a standard diet [81]. These experiments mimicking the chronic carrier state support an important role for biofilms in recalcitrance of chronic S. Typhi infections to antibiotic treatment and are consistent with clinical data [70,82,83]. Studies performed in a murine gall stone model using S. Typhimurium support a role of biofilm formation in the gall bladder in the chronic typhoid carrier state.…”

Non-typhoidal Salmonella in Children: Microbiology, Epidemiology and Treatment

“…Treatment of chronic NTS carriage is recommended in one source, based on data for the eradication of chronic Salmonella Typi and Paratyphi [57,70] (Table 2.4). In patients with HIV infection, prolonged ciprofloxacin (minimum 3 months) may also reduce NTS relapse [71] and up to 6 months suppressive treatment is recommended for HIV-infected adolescents and adults with recurrent NTS bacteraemia [72].…”

Multi-Locus Variable-Number Tandem Repeat Profiling of Salmonella enterica Serovar Typhi Isolates from Blood Cultures and Gallbladder Specimens from Makassar, South-Sulawesi, Indonesia

“…S. Typhi infection of the bile-rich gallbladder may result in a persistent local infection which then could lead to a chronic carrier state. With adequate treatment most typhoid patients clear the pathogen but nearly 3–5% is estimated to become carrier [13]. S. Typhi infection of the biliary tract is often accompanied with abnormalities such as inflammation and gallstones [14].…”