Resistance Patterns of Typhoid Fever in Children: A Longitudinal Community-Based Study

Abstract

Salmonella typhi and S. paratyphi are important causes of bacteremia in children, especially those from the developing world. There is a lack of standardized treatment protocols for such patients in the literature, and there are also reports of therapeutic failure related to resistance to commonly used antibiotics. We analyzed the epidemiological, clinical, and antimicrobiological sensitivity patterns of disease in patients diagnosed with blood culture-positive typhoid fever over a 6-month period in a tertiary-care pediatric hospital in western India. Data were retrospectively analyzed for all patients with Salmonella isolates on blood culture between January 1 and June 30, 2011 at the Synergy Neonatal and Pediatric Hospital. Susceptibility of isolates to antimicrobials and minimum inhibitory concentrations were determined. Demographic data, symptoms and signs, basic laboratory results, treatment courses, and clinical outcomes were collected from clinical charts. All of the 61 isolates of S. typhi were sensitive to cefepime (fourth-generation cephalosporin), 96% to third-generation cephalosporins, and 95% to quinolones. There was intermediate sensitivity to ampicillin (92%) and chloramphenicol (80%). Notably, azithromycin resistance was observed in 63% of isolates. All patients ultimately made full recoveries. There is an urgent need for large scale, community-based clinical trials to evaluate the effectiveness of different antibiotics in enteric fever. Our antimicrobial susceptibility data suggest that quinolones and third-generation cephalosporins should be used as first-line antimicrobials in enteric fever. Although fourth-generation cephalosporins are useful, we feel their use should be restricted to complicated or resistant cases.

Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis

“…For the 34 studies that reported at least one organism, but ≤ 5% ceftriaxone-resistant isolates, disc diffusion was the standard testing method. Only five studies additionally determined MICs: two by agar dilution [45, 65] and three by E -test [76–78]. However, ceftriaxone resistance was not confirmed by E -test in one study [76].…”

Pattern of Antimicrobial Susceptibility for Salmonella Typhi in Dhaka Medical College Hospital from 2013-2014

“…14,19,20 In our study azythromycin resistance is increasing (29%) and it also correlates with other study. 12,16 In the present study 100% Salmonella were sensitive to ceftriaxone which is the drug of choice in Dhaka Medical College and other parts of Bangladesh to treat typhoid fever. In Bangladesh so far no ceftriaxone resistant Salmonella has been identified.…”

Management of bacterial severe sepsis and septic shock

“…In developing countries, empiric therapy should also cover S. typhi, which is increasingly resistant to ampicillin, chloramphenicol, and cotrimoxazole. Alternative therapies include fluoroquinolones, third generation cephalosporins, or azithromycin with empiric treatment decisions based on local susceptibility patterns and severity of illness [95].…”