trimethoprim--sulfamethoxazole-drug-combination and Paratyphoid-Fever

Pefloxacin, which has been shown to have a high in vitro activity against Salmonella spp., was compared to cotrimoxazole in the treatment of typhoid fever in adults. In a prospective, randomized trial, 42 patients with bacteriologically documented typhoid fever received either 400 mg pefloxacin b.i.d. or 160/800 mg cotrimoxazole b.i.d. Duration of treatment was 14 days in both groups. All patients were cured without experiencing a relapse or becoming a salmonella carrier. Apyrexia and resolution of digestive and neurological symptoms were obtained in a significantly shorter time with pefloxacin than with cotrimoxazole. Pefloxacin was well tolerated and more effective than cotrimoxazole in the treatment of typhoid fever.

Topics: Adult; Drug Combinations; Female; Humans; Male; Norfloxacin; Paratyphoid Fever; Pefloxacin; Prospective Studies; Random Allocation; Salmonella paratyphi A; Salmonella paratyphi B; Salmonella typhi; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

We report a case of recurrent, multifocal Salmonella enterica serotype Paratyphi A breast abscesses, resistant to ciprofloxacin, which relapsed despite surgery, aspiration and multiple courses of antibiotics, including co-trimoxazole and azithromycin. The patient was cured after a prolonged course of intravenous ceftriaxone.

Topics: Abscess; Administration, Oral; Adult; Anti-Bacterial Agents; Azithromycin; Breast Diseases; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Female; Humans; Infusions, Intravenous; Paratyphoid Fever; Recurrence; Salmonella paratyphi A; Suction; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To define the genetic characteristics and resistance mechanisms of clinical isolates of Salmonella enterica serovar Typhi (S. Typhi) and S. enterica serovar Paratyphi A (S. Paratyphi A) exhibiting high-level fluoroquinolones resistance.. Three S. Typhi and two S. Paratyphi A ciprofloxacin-resistant isolates (MICs > 4 mg/L) were compared with isolates with reduced susceptibility to ciprofloxacin (MICs 0.125-1 mg/L) by PFGE, plasmid analysis, presence of integrons and nucleotide changes in topoisomerase genes.. In S. Typhi and Paratyphi A, a single gyrA mutation (Ser-83-->Phe or Ser-83-->Tyr) was associated with reduced susceptibility to ciprofloxacin (MICs 0.125-1 mg/L); an additional mutation in parC (Ser-80-->Ile, Ser-80-->Arg, Asp-69-->Glu or Gly-78-->Asp) was accompanied by an increase in ciprofloxacin MIC (> or = 0.5 mg/L). Three mutations conferred ciprofloxacin resistance: two in gyrA (Ser-83-->Phe and Asp-87-->Asn or Asp-87-->Gly) and one in parC. This is the first report of parC mutations in S. Typhi. Ciprofloxacin-resistant S. Typhi and S. Paratyphi A differed in their MICs and mutations in gyrA and parC. Moreover S. Typhi harboured a 50 kb transferable plasmid carrying a class 1 integron (dfrA15/aadA1) that confers resistance to co-trimoxazole and tetracycline but not to ciprofloxacin. PFGE revealed undistinguishable XbaI fragment patterns in ciprofloxacin-resistant S. Typhi as well as in S. Paratyphi A isolates and showed that ciprofloxacin-resistant S. Typhi have emerged from a clonally related isolate with reduced susceptibility to ciprofloxacin after sequential acquisition of a second mutation in gyrA.. To our knowledge this is the first report of molecular characterization of S. Typhi with full resistance to ciprofloxacin. Notably, the presence of a plasmid-borne integron in ciprofloxacin-resistant S. Typhi may lead to a situation of untreatable enteric fever.

Topics: Amino Acid Substitution; Anti-Bacterial Agents; Ciprofloxacin; Deoxyribonucleases, Type II Site-Specific; DNA Gyrase; DNA Topoisomerase IV; DNA Topoisomerases; DNA, Bacterial; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Humans; India; Integrons; Microbial Sensitivity Tests; Mutation, Missense; Paratyphoid Fever; Plasmids; Salmonella paratyphi A; Salmonella typhi; Sequence Analysis, DNA; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Adult; Animals; Blastocystis Infections; Ceftriaxone; Ciprofloxacin; Drug Resistance, Microbial; Drug Resistance, Multiple; Humans; Male; Metronidazole; Paratyphoid Fever; Salmonella paratyphi A; Species Specificity; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

Salmonella paratyphi B is a pathogenic agent causing outbreaks and keeping epidemiologic importance. The classical treatment of this disease is made by ampicillin, chloramphenicol, and co-trimoxazole in resistant strain. The resistant strains tends to cause a treatment problem. We report treatment and antibiogram results of 48 patients exactly diagnosed as paratyphi B infection by clinic and laboratory evaluation. These patients came to pediatric clinic of Erzincan state Hospital from Erzincan town and its backgrounds and had ages between 3 months and 5 years. All isolates were resistant to ampicillin, chloramphenicol and cotrimoxazole but usually sensitive to 3. generation cephalosporins (Cefotaxime had greatest sensitivity ratio with 79.1%) and amikacin.

Topics: Amikacin; Ampicillin Resistance; Cefotaxime; Cephalosporins; Child, Preschool; Chloramphenicol; Drug Resistance, Microbial; Humans; Infant; Paratyphoid Fever; Salmonella; Salmonella paratyphi B; Trimethoprim, Sulfamethoxazole Drug Combination

The response of 310 patients with typhoid or paratyphoid fevers to current antibiotic therapy was studied retrospectively. Most patients were of Asian or European origin, thus reflecting the areas in which they were infected. Of the 244 patients with well-recorded therapy 63% were treated with chloramphenicol, 22% with co-trimoxazole and the remainder with various penicillins. There was little difference in response in terms of resolution of fever. Symptoms persisted in only two of 153 (1.3%) patients given chloramphenicol but side-effects led to a change of treatment in nine of these patients. Co-trimoxazole was not significantly inferior and amoxycillin performed well, but the small number of cases treated with ampicillin or mecillinam did not respond as well as those treated with the other drugs.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Bacterial Agents; Child; Child, Preschool; Chloramphenicol; Drug Combinations; Female; Humans; Male; Middle Aged; Netherlands; Paratyphoid Fever; Retrospective Studies; Sulfamethoxazole; Surveys and Questionnaires; Travel; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; United Kingdom

Topics: Adolescent; Adult; Aged; Bile; Carrier State; Child; Drug Combinations; Feces; Female; Humans; Male; Middle Aged; Paratyphoid Fever; Salmonella paratyphi A; Salmonella typhi; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever