Salmonella Typhi Infections and Effect of Fluroquinolones and Third Generation Cephalosporins in Clinical Outcome

Abstract

Background: Enteric fever is a common public health problem in Nepal. The emerging fluoroquinolone resistance to Salmonella typhi is a major concern in every hospital and is a public health problem these days. Continuous antibiotic susceptibility patterns surveillance and standard treatment policies need to be established to control MDR typhoid. Objective: To detect the increasing pattern of fluoroquinolone resistant Salmonella typhi and to correlate its clinical response to third generation cephalosporins. Materials and Method: This is a cross-sectional prospective study conducted in the pediatric ward of Birendra Hospital, Kathmandu, from September 2009 to August 2010. Forty seven children aged between 3-14 years with the diagnosis of suspected, probable and confirmed cases of Enteric fever were enrolled in the study. Data was collected and statistical analysis was done using SPSS program. Result: Culture positive enteric fever was found in 21 cases (44.68%) and positive Widal test in 18 (38.29%). Among the culture positive cases, antibiotic sensitivity was highest for Ofloxacin (95.23%), followed by third generation Cephalosporins (Ceftriaxone, Cefixime) (90.47%). A significant number of isolates were resistant to Nalidixic acid (71.42%). All cases were successfully treated with parenteral antibiotics followed by oral third generation cephalosporins without any complications and/or mortality. Conclusion: There is an increasing trend to fluoroquinolone resistant Salmonella typhi. Third generation cephalosporin can be the appropriate antibiotic for treatment.of clinically suspected cases of Enteric fever and to minimize the risk of increasing emergence of MDR enteric fever including Nalidixic acid resistant Typhoid.(NARST).

Is Antimicrobial Resistance Pattern of Enteric Fever Changing in Kathmandu Valley?

“…The most commonly aff ected age group (6-10 year) reported in this series is similar to the fi ndings observed by Sharma AK 22 and Singh et al 25 . This age group is more vulnerable to exposure to contaminated foods and water and has not still developed the immunity against the disease.…”

“…This type of seasonal distribution of enteric fever is the typical description of occurrence of enteric fever as mentioned in the textbooks. Similar observations were seen in other series as well 22,23,24,25 . The seasonal variation of occurrence of enteric fever is considered due to more chances of contamination of foods and water by faeces of infected persons and healthy carriers in the rainy season.…”

“…However, the concern is with reported high percentages of intermediate sensitivity to ceftriaxone (45.2% for S typhi and 56.2% for paratyphi A). The high resistance rate of cefi xime (19.0%) found in this series contradicts the observations made by other studies (1.0% by Jamil et al 17 and 9.6% by Singh et al 25 ). This high reported resistance of Salmonella sp to cefi xime in the present study could be due to rampant irrational use of cefi xime in the communities.…”

“…The commonly used third generation cephalosporins viz. cefi xime, cefotaxime and ceftriaxone for the treatment of enteric fever have been found resistant by some studies in Nepal as well, although the resistance reported is low 23,25 . The present study also observed cefotaxime and ceftriaxone eff ective in vitro treatment of Salmonella sp.…”

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“…A study done in Birendra hospital Kathmandu reported that Ofloxacin was most sensitive antibiotic in 95.23 % cases followed by third generation cephalosporins (Ceftriaxone and Cefixime) in 90.47 % cases. Researchers concluded that third generation cephalosporins may be the alternative for the treatment of fluoroquinolone resistant typhoid fever 23 . On the reference to these facts we reviewed current treatment pattern of typhoid fever in Nepal.…”