Professional Documents
Culture Documents
1:3
12
Cephalosporins
Trials of ceftriaxone show that fever defervescence takes
longer and relapses occur in patients treated for shorter
duration. It is recommended for 14 days. This antibiotic is
safe and achieves good clinical cure.
Chloramphenicol
The reduced use of chloramphenicol has increased sensitivity
to chloramphenicol. Reversal may be due to loss of plasmids
encoding resistance to chloramphemicol. It is making a
comeback in developing countries.
Prevention
Azithromycin
Vaccines
While Ty 21a and Vi polysaccharide vaccines are effective,
development of cheap, safe vaccines with efficacy among
infants which can provide protective immunity after single
does is required. The growing importance of S. A as a cause
of enteric fever is of great concern particularly due to lack of
effective vaccine available. CDC has issued special guidelines
for typhoid vaccination in travelers to endemic countries.
Conclusions
Enteric fever continues to be important cause of illness with
estimated global burden of greater than 27 million cases per
annum with a clinical relapse rate of 5% to 20%. In India there
have been increasing reports of Salmonella enterica serotype
A causing enteric fever in addition to serotype. Typhoid
vaccine does not offer protection against paratyphi
Fluoroquinolones
Quinolones including ciprofloxacin and ofloxacin were drugs
of choice for most cases of enteric fever. However reports of
resistance to fluoroquinolones in the form of nalidixic acid
resistance which correlates with decreased ciprofloxacin
susceptibility (DCS) was reported in 1990s. In Asian countries
this gave rise to them being rendered ineffective therapy.
Gatifloxacin gave good results in 2 trials that used 7 day
courses, had low MIC (minimum inhibitory concentration)
for bacterial strains with DCS and is suggested to be more
effective than older fluoroquinolones owing to better results
of time-kill experiments but its use was associated with more
relapses than with azithromycin. In a recent paper in the Lancet
infectious disease from Nepal Gatifloxacin was compared to
13
References
1.
Jenkins C, Gillespie SH. Salmonella infections. In Mansons Tropical Diseases(22nd ed.) eds Gordon Cook, A. Zumla. Saunders
Elsevier publication 2009.
2.
3.
Gupta SK, Medalla F, Omondi MW et al. Laboratory based surveillance of paratyphoid fever in the United States: travel and antimicrobial resistance. Clin Inf Dis 2008;46:1656-63.
11. Parry CM, Ho VA, Phuong IT et al. Randomized controlled comparison of oflaxacin, azithromycin and ofloxacin azithromycin
combination for treatment of multidrug resistant and Nalidixic
acid resistant Typhoid fever. Antimicrob Agents Chemother
2007;51:819-25.
12. Hooper DC. Mechanisms of action and resistance of older and
newer fluoroquinolones. Clin Inf. Dis. 2000;31:524-28.
13. Beeching NJ, Parry CM. Outpatient treatment of patients with enteric fever. Lancet Inf. Dis. 2011;11:420-21.
14. Arjyal A, Basnyat B, Koirala S, et al. Gatifloxacin versus chloramphenicol for uncomplicated enteric fever: an open label randomized controlled trial. Lancet Inf. Dis, 2011;11:445-54.
6.
15. Jog S, Soman R, Singhal T et al. Enteric fever in Mumbai clinical profile, sensitivity patterns and response to antimicrobials. J
Assoc. Physicians India 2008;56:237-40.
16. Rodriques C. The Widal test More than 100 years old: Abused
but still used. J. Assoc. Physicians India 2003;51:7-8.
9.
Molloy A, Nair S, Cooke FJ et al. First report of salmonella enterica A azithromycin resistance leading to treatment failure. J Clin.
Microbiol 2010;48:4655-4657.
10. Bhattacharya SS, Das U, Chaudhary BK. Occurrence and antiboigram of salmonella and S. A isolated from Rourkela, Orissa. India
J. Med. Res. 2011;133(4):431-433.
14