fosfomycin and Typhoid-Fever

We report a traveler who acquired a Salmonella enterica subspecies enterica serovar Typhi strain with resistance against β-lactams, cephalosporins (extended-spectrum β-lactamase-producing type SHV-12), and quinolones (plasmid-mediated quinolone resistance gene qnrB7). After clinical deterioration using meropenem monotherapy, treatment success was achieved after commencement of fosfomycin in conjunction with high-dose meropenem. The case illustrates clinical challenges of multidrug-resistant S. Typhi.

Topics: Anti-Bacterial Agents; beta-Lactamases; Drug Resistance, Multiple, Bacterial; Fluoroquinolones; Fosfomycin; Humans; Male; Meropenem; Salmonella typhi; Thienamycins; Typhoid Fever

Multi-drug resistant strains of Salmonella isolated from blood and bone marrow cultures of pyrexial patients received from physicians, hospitals and different clinics were studied from May to November, 1993. Of 2143 samples collected, 424(20%) cases yielded the growth of different organisms. Out of these 266(63%) were positive for Salmonella strains. The strains isolated were Salmonella typhi 239(90%) and Salmonella paratyphi A 27(10%). Two hundred twenty (82%) strains of Salmonella showed increased beta-lactamase activity and an alarming increase in resistance against commonly used antibiotics for enteric fever.

Topics: 4-Quinolones; Anti-Infective Agents; Bacteremia; beta-Lactamases; Bone Marrow; Cephalosporin Resistance; Chloramphenicol Resistance; Drug Resistance, Microbial; Drug Resistance, Multiple; Fosfomycin; Humans; Penicillin Resistance; Salmonella paratyphi A; Salmonella typhi; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Treatment with fosfomycin alone and associated to subtherapeutic doses of chloramphenicol or of ampicillin, has been tried on 50 patients with typhoid fever and on four carriers of S. typhi in the Hospital del Rey. 15 patients were treated with fosfomycin alone, 22 with fosfomycin plus chloramphenicol and 13 with fosfomycin plus ampicillin. The treatment lasted 15-20 days. The results have been evaluated clinically and bacteriologically, haemo- and coprocultures being carried out. The sensitivity of the isolated germs has been studied, including MIC and the synergism in vitro between fosfomycin-chloramphenicol and fosfomycin-ampicillin. Fosfomycin, chloramphenicol and ampicillin determinations have been carried out on the blood. The cures obtained were 67, 82 and 92% respectively with fosfomycin, fosfomycin-chloramphenicol and fosfomycin-ampicillin. We believe that this antibiotic can be useful in the treatment of typhoid fever, associating it to chloramphenicol or ampicillin, due to the synergism existing between them and given the results we have obtained.

Topics: Administration, Oral; Adolescent; Adult; Aged; Ampicillin; Anti-Bacterial Agents; Child; Chloramphenicol; Drug Combinations; Drug Evaluation; Drug Synergism; Female; Fosfomycin; Humans; Injections, Intramuscular; Male; Middle Aged; Time Factors; Typhoid Fever