Effectiveness of treatment regimens for Typhoid fever in the nalidixic acid-resistant S. typhi (NARST) era in South India.

Abstract

The epidemiology of typhoid fever in South Asia has changed. Multi-drug resistant (MDR) Salmonella typhi ( S. typhi) is now frequently resistant to nalidixic acid and thus labelled NARST. Treatment failure with the use of fluoroquinolones has been widely noted, forcing clinicians to adopt alternative treatment strategies. In this observational study, we looked at various treatment regimens and correlated clinical and microbiological outcomes. In 146 hospitalised adults, the median minimum inhibitory concentration (MIC) for ciprofloxacin was 0.38 µg/mL with a median fever clearance time (FCT) of eight days (range = 2-35 days). Of the regimens used, gatifloxacin and azithromycin had a shorter FCT of six days compared to ceftriaxone (ten days; P < 0.001). Though mortality and relapse in our cohort was low, NARST seemed to correlate with mortality ( P = 0.006). Gatifloxacin or azithromycin clearly emerge as the drugs of choice for treatment of typhoid in South India.

• Authors: Rini Bandyopadhyay, Veeraghavan Balaji, Bijesh Yadav, Sudha Jasmine, Sowmya Sathyendra, Priscilla Rupali
• Journal: Tropical doctor (Trop Doct) Vol. 48 Issue 3 Pg. 182-188 (Jul 2018) ISSN: 1758-1133 [Electronic] England
• PMID: 29495943 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents
• Anti-Infective Agents
• Fluoroquinolones
• Nalidixic Acid
• Ciprofloxacin
• Azithromycin
• Gatifloxacin

Topics

• Adult
• Anti-Bacterial Agents (therapeutic use)
• Anti-Infective Agents (therapeutic use)
• Azithromycin (therapeutic use)
• Ciprofloxacin (therapeutic use)
• Cohort Studies
• Drug Resistance, Multiple, Bacterial
• Female
• Fluoroquinolones (therapeutic use)
• Gatifloxacin
• Hospitalization
• Humans
• India (epidemiology)
• Male
• Microbial Sensitivity Tests
• Nalidixic Acid (therapeutic use)
• Recurrence
• Salmonella typhi (drug effects)
• Treatment Outcome
• Typhoid Fever (drug therapy, epidemiology, microbiology)
• Young Adult