Response of extensively drug resistant Salmonella Typhi to treatment with meropenem and azithromycin, in Pakistan

Abstract

Introduction Salmonella Typhi is one of the leading health problems in Pakistan. With the emergence of extensively drug resistant (XDR) Salmonella Typhi, treatment options are limited. Here we report the clinical manifestations and the response to treatment of patients with XDR Typhoid fever. The patients were treated with either Meropenem or Azithromycin or a combination of both. Methods We reviewed the records of culture confirmed XDR typhoid who visited Aga Khan University Hospital (AKUH), Karachi and Aga Khan Secondary Care Hospital, Hyderabad from April 2017 to June 2018. Symptoms developed during disease, unplanned treatment extension and complications developed while on antimicrobials was recorded. Means with standard deviation were calculated for duration of treatment, time to defervescence, and cost of treatment. Results Records of 81 culture confirmed XDR typhoid patients admitted at the AKU hospitals were reviewed. Most, (n = 45; 56%) were male. Mean age of the cases was 8.03 years with range (1-40). About three quarter (n = 66) of the patients were treated as inpatient. Fever and vomiting were the most common symptoms at the time of presentation. Oral azithromycin alone (n = 22; 27%), intravenous meropenem alone (n = 20; 25%), or a combination of azithromycin and meropenem (n = 39; 48%) were the options used for treatment. Average (95% confidence interval) time to defervescence was 7.1(5.5-8.6), 6.7(4.7-8.7), and 6.7 (5.5-7.9) days for each treatment option respectively whereas there were 1,0 and 3 treatment failures in each treatment option respectively.

Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan

“…Use of therapeutic anticoagulation, two doses of Tocilizumab and Azithromycin was more frequent among non-survivors in our data. Azithromycin is the only effective oral drug for treatment of XDR salmonella [ 31 ] and COVID-19 pandemic has led to its mass injudicious use, both over the counter and prescription driven, which may increase antimicrobial resistance in the long run. Studies have failed to demonstrate any benefit of AZT alone [ 32 ] or in combination with HCQ [ 33 ] with a risk of compounding cardiac toxicity by QTc prolongation [ 34 ].…”

Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan

“…HCQ despite inhibiting viral replication in vitro [25] did not prove beneficial in RCTs [26], rather proved to be toxic .This led to the FDA revoking its emergency use authorization in June 2020 [27]. AZT is the only effective oral drug for treatment of XDR salmonella [28] and COVID-19 pandemic has led to its mass injudicious use, both over the counter and prescription driven, which may increase antimicrobial resistance in the long run. Studies have failed to demonstrate any benefit of AZT alone [29] or in combination with HCQ [30] with a risk of compounding cardiac toxicity by QTc prolongation [31].…”

A review of clinical profile, complications and antibiotic susceptibility pattern of extensively drug-resistant (XDR) Salmonella Typhi isolates in children in Karachi

“…This finding has important future implications as our data suggests that XDR S.Typhi can be successfully treated with oral azithromycin, which will reduce the cost of treatment and hospital admission. Qureshi et al [25] also reported that treatment of XDR S.Typhi by meropenem is more expensive than azithromycin. They reported an average daily cost of treatment for azithromycin to be US$5.87 versus US$88 for meropenem.…”