trimethoprim--sulfamethoxazole-drug-combination and Typhoid-Fever

Multidrug-resistant typhoid fever (MDRTF) is defined as typhoid fever caused by Salmonella enterica serovar Typhi strains (S. Typhi), which are resistant to the first-line recommended drugs for treatment such as chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole. Since the mid-1980s, MDRTF has caused outbreaks in several countries in the developing world, resulting in increased morbidity and mortality, especially in affected children below five years of age and those who are malnourished.. Two methods were used to gather the information presented in this article. First PubMed was searched for English language references to published relevant articles. Secondly, chapters on typhoid fever in standard textbooks of paediatric infectious diseases and preventive and social medicine were reviewed.. Although there are no pathognomonic clinical features of MDRTF at the onset of the illness, high fever ( > 104°F), toxaemia, abdominal distension, abdominal tenderness, hepatomegaly and splenomegaly are often reported. The gold standard for the diagnosis of MDRTF is bacterial isolation of the organism in blood cultures. Ciprofloxacin and ceftriaxone are the drugs most commonly used for treatment of MDRTF and produce good clinical results.. MDRTF remains a major public health problem, particularly in developing countries. Mass immunization in endemic areas with either the oral live attenuated Typhi 21a or the injectable unconjugated Vi typhoid vaccine, rational use of antibiotics, improvement in public sanitation facilities, availability of clean drinking water, promotion of safe food handling practices and public health education are vital in the prevention of MDRTF.

Topics: Ampicillin; Anti-Bacterial Agents; Chloramphenicol; Communicable Disease Control; Disease Outbreaks; Drug Resistance, Multiple, Bacterial; Humans; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

We describe the first case of typhoid spondylodiscitis in Southeast Asia, and the literature were also reviewed. A 57-year-old diabetic Thai man who presented with a one-month course of progressive low back pain associated with paraparesis and bowel-bladder dysfunction. Examination revealed local tenderness over T12 area, spastic paraparesis, impaired pinprick sensation up to T12 level, and loose anal sphincter tone. Magnetic resonance imaging showed spondylodiscitis of T11 and T12 and epidural abscess causing spinal cord compression. T11 and T12 laminectomy, T11/12 discectomy, and debridement of epidural abscess were performed, and the cultures of the pus grew Salmonella Typhi. He was treated with intravenous ciprofloxacin for three weeks and was discharged from the hospital with oral ciprofloxacin and trimethoprim-sulfamethoxazole for another five months of treatment. The patient was doing well when last seen two months after discontinuation of antimicrobial treatment. In addition, a total of ten cases of typhoid spondylitis/spondylodiscitis were reviewed.

Topics: Anti-Infective Agents; Ciprofloxacin; Diagnosis, Differential; Discitis; Drug Therapy, Combination; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Thailand; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

The introduction of chloramphenicol in 1948 revolutionised the outcome of typhoid fever but chloramphenicol-resistant strains of Salmonella enterica serotype Typhi were reported just two years later. Resistance followed also the introduction of ampicillin and co-trimoxazole. During the second half of the 1980s, strains resistant to the three first-line antimicrobial agents, chloramphenicol, ampicillin and co-trimoxazole emerged and spread rapidly throughout the Indian subcontinent and South East Asia. During the 1990s when fluoroquinolones had become a first-line treatment for typhoid fever, these multi drug resistant (MDR) strains acquired an additional resistance to nalidixic acid with decreased susceptibilities to ciprofloxacin (CIPDS) (MIC range, 0.125-1 mg/l). Considerable data have now accumulated to suggest that infections due to CIPDS strains may not respond satisfactorily to therapy with ciprofloxacin or ofloxacin. Furthermore, identification of such CIPDS strains in clinical laboratories is not easy without determination of MIC of ciprofloxacin. Recently, several isolates highly resistant to ciprofloxacin or to extended-spectrum cephalosporins of Asian origin have been reported.

Topics: Ampicillin; Anti-Bacterial Agents; Chloramphenicol; Ciprofloxacin; Drug Resistance; Drug Resistance, Multiple; Humans; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Azithromycin and trimethoprim-sulfamethoxazole (SXT) are widely used to treat undifferentiated febrile illness (UFI). We hypothesized that azithromycin is superior to SXT for UFI treatment, but the drugs are noninferior to each other for culture-confirmed enteric fever treatment.. We conducted a double-blind, randomized, placebo-controlled trial of azithromycin (20 mg/kg/day) or SXT (trimethoprim 10 mg/kg/day plus sulfamethoxazole 50 mg/kg/day) orally for 7 days for UFI treatment in Nepal. We enrolled patients >2 years and <65 years of age presenting to 2 Kathmandu hospitals with temperature ≥38.0°C for ≥4 days without localizing signs. The primary endpoint was fever clearance time (FCT); secondary endpoints were treatment failure and adverse events.. From June 2016 to May 2019, we randomized 326 participants (163 in each arm); 87 (26.7%) had blood culture-confirmed enteric fever. In all participants, the median FCT was 2.7 days (95% confidence interval [CI], 2.6-3.3 days) in the SXT arm and 2.1 days (95% CI, 1.6-3.2 days) in the azithromycin arm (hazard ratio [HR], 1.25 [95% CI, .99-1.58]; P = .059). The HR of treatment failures by 28 days between azithromycin and SXT was 0.62 (95% CI, .37-1.05; P = .073). Planned subgroup analysis showed that azithromycin resulted in faster FCT in those with sterile blood cultures and fewer relapses in culture-confirmed enteric fever. Nausea, vomiting, constipation, and headache were more common in the SXT arm.. Despite similar FCT and treatment failure in the 2 arms, significantly fewer complications and relapses make azithromycin a better choice for empirical treatment of UFI in Nepal.. NCT02773407.

Topics: Anti-Bacterial Agents; Azithromycin; Double-Blind Method; Humans; Nepal; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Undifferentiated febrile illness (UFI) includes typhoid and typhus fevers and generally designates fever without any localizing signs. UFI is a great therapeutic challenge in countries like Nepal because of the lack of available point-of-care, rapid diagnostic tests. Often patients are empirically treated as presumed enteric fever. Due to the development of high-level resistance to traditionally used fluoroquinolones against enteric fever, azithromycin is now commonly used to treat enteric fever/UFI. The re-emergence of susceptibility of Salmonella typhi to co-trimoxazole makes it a promising oral treatment for UFIs in general. We present a protocol of a randomized controlled trial of azithromycin versus co-trimoxazole for the treatment of UFI.. This is a parallel-group, double-blind, 1:1, randomized controlled trial of co-trimoxazole versus azithromycin for the treatment of UFI in Nepal. Participants will be patients aged 2 to 65 years, presenting with fever without clear focus for at least 4 days, complying with other study criteria and willing to provide written informed consent. Patients will be randomized either to azithromycin 20 mg/kg/day (maximum 1000 mg/day) in a single daily dose and an identical placebo or co-trimoxazole 60 mg/kg/day (maximum 3000 mg/day) in two divided doses for 7 days. Patients will be followed up with twice-daily telephone calls for 7 days or for at least 48 h after they become afebrile, whichever is later; by home visits on days 2 and 4 of treatment; and by hospital visits on days 7, 14, 28 and 63. The endpoints will be fever clearance time, treatment failure, time to treatment failure, and adverse events. The estimated sample size is 330. The primary analysis population will be all the randomized population and subanalysis will be repeated on patients with blood culture-confirmed enteric fever and culture-negative patients.. Both azithromycin and co-trimoxazole are available in Nepal and are extensively used in the treatment of UFI. Therefore, it is important to know the better orally administered antimicrobial to treat enteric fever and other UFIs especially against the background of fluoroquinolone-resistant enteric fever.. ClinicalTrials.gov, ID: NCT02773407 . Registered on 5 May 2016.

Topics: Administration, Oral; Adolescent; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Clinical Protocols; Double-Blind Method; Drug Resistance, Bacterial; Female; Fever; Humans; Male; Middle Aged; Nepal; Research Design; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; Typhus, Epidemic Louse-Borne; Young Adult

In 28 children, with bacteriologically and/or serologically diagnosed typhoid fever treated at CMH, Rawalpindi in 2003, first one of the three recommended drugs (viz. chloramphenicol, amoxycillin or co-trimoxazole) was given for 7 days for defervescence to occur. In those who failed to respond a second trial of therapy with one of the other two drugs was initiated, after excluding the first drug. A second failure of therapy was taken as an indication to use pefloxacin singly. Finally, 18 (64.3%) cases responded to chloramphenicol or amoxycillin or co-trimoxazole. Pefloxacin was used in 10 (35.7%) cases. The failure rate of treatment with chloramphenicol was 50%, with amoxycillin 71.4% with co-trimoxazole 75% and 0% with pefloxacin. An analysis of the 28 cases revealed that apart from fever (in 100%), splenomegaly (in 82.1%) was the most important clinical indicator to diagnosis. along with absolute eosinopenia (in 71.4%). There were no major complications, except 2 cases with typhoid hepatitis that responded to choramphenicol and co-trimoxazole, respectively. Blood culture grew Salmonella typhi in 7 cases of which 5 (72%) were multi drug resistant S. typhi.

Topics: Amoxicillin; Anti-Bacterial Agents; Blood Cell Count; Child; Child, Preschool; Chloramphenicol; Female; Humans; Liver Function Tests; Male; Pefloxacin; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Adolescent; Amdinocillin; Amoxicillin; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Male; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Amoxicillin; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Chloramphenicol Resistance; Drug Resistance, Microbial; Female; Humans; In Vitro Techniques; Infant; Male; Recurrence; Salmonella typhi; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid 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

An outbreak of typhoid fever occurred among 54 hospital nurses after a picnic. The salient features were fever (100%), nausea and vomiting (46%), loose motions and abdominal pain (13%), and palpable splenomegaly (63%). None of the patients had any major complications. Blood cultures for Salmonella typhi were positive in 81%, blood Widal was positive (1:320 or more) in 43% and suggestive (1:160) in 25% of the blood culture positive patients. A comparable number of patients were administered chloramphenicol or co-trimoxazole and no differences in response were observed. Bacteriological examination of samples of water from the likely sources revealed it to be unfit for human consumption due to gross faecal contamination.

Topics: Adolescent; Adult; Anti-Infective Agents; Chloramphenicol; Disease Outbreaks; Drug Combinations; Female; Food Contamination; Humans; India; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

A double-blind study on 72 adult patients affected by typhoid fever was done utilizing a new sulfa-trimethoprim combination (trimethoprim-sulfamethopyrazine) versus the well-known combination trimethoprim-sulfamethoxazole. The dosage used for the new drug was 2 capsules (250 mg trimethoprim + 200 mg sulfamethopyrazine per capsule) the 1st day and 1 capsule for the following 14 days or 2 capsules (trimethoprim 80 mg + sulfamethoxazole 400 mg per capsule) twice daily for 15 days. Both drugs proved to be very effective according to the parameters considered. No complications (intestinal bleeding, perforation, etc.) occurred in any of the patients, and untoward effects were not observed. It is therefore our opinion that treatment of typhoid fever with a sulfa-trimethoprim combination is both effective and safe.

Topics: Adolescent; Adult; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Female; Humans; Male; Random Allocation; Sulfalene; Sulfamethoxazole; Sulfanilamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Typhoid fever is an infectious disease with multisystem involvement and is commonly seen in the tropics. Twelve patients with acute typhoid fever were successfully treated with a fixed dose combination of pivmecillinam and pivampicillin. The treatment results were compared to those obtained from the treatment of ten other patients with co-trimoxazole, which is the routine treatment of our Department. The two forms of treatment appeared to be equally effective, suggesting that the combination mecillinam/ampicillin may represent a valuable alternative to the antityphoidal drugs currently available. Eleven patients were infected with strains resistant in vitro to either ampicillin, chloramphenicol, or both. All clinical isolates were sensitive to co-trimoxazole and to the combination of mecillinam and ampicillin. MIC values for the combination ranged from 0.16 to 2.5 mg/l. No side-effects were recorded.

Topics: Adolescent; Adult; Amdinocillin Pivoxil; Ampicillin; Drug Combinations; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Male; Penicillanic Acid; Pivampicillin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Infections with non-typhoidal Salmonella sp. have been documented in children with chronic granulomatous disease (CGD), but the prevalence of salmonella infection in children with CGD in underdeveloped countries is unknown. We assessed the clinical profiles of CGD patients diagnosed at our tertiary care centre in north India and had Salmonella sp.infections. We found three patients with Salmonella sp. bloodstream infections (2-proven, 1-probable) among the 99 CGD patients. After receiving cotrimoxazole prophylaxis following a CGD diagnosis, we noted that none of our patients experienced non-typhoidal salmonella infection. One patient experienced severe typhoidal bacteremia despite receipt of cotrimoxazole prophylaxis. This patient required numerous hospital admissions and prolonged intravenous antibiotic regimen. We suggest that vaccination with killed typhoidal vaccines should be regularly given to children with CGD in order to avoid typhoidal bacteremia, in addition to cotrimoxazole prophylaxis and a focus on good hand and food hygiene.

Topics: Bacteremia; Child; Granulomatous Disease, Chronic; Humans; Salmonella; Salmonella Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Enteric fever is a major health problem in Bangladesh. Antibiotic resistance especially against first-line antibiotics is a major concern in the management and thereby not practicing by physician as first choice thinking their resistance. This retrospective study was carried out in the Department of Microbiology, Bangladesh Medical College Hospital, Dhaka, Bangladesh from January of 2017 to December of 2019 to identify the year wise sensitivity pattern of first-line antibiotics like Amoxycillin, Cotrimoxazole and Chloramphenocol against Salmonella typhi and Salmonella paratyphi. All the blood samples sent for culture and sensitivity were evaluated to see the microbiom and their sensitivity pattern. Salmonella typhi and paratyphi were the major isolates in last 3 years which were 73.74% and 15.32% respectably. Sensitivity pattern of Amoxycillin, Cotrimoxazole and Chloramphenocol for Salmonella typhi is increased from 2017 to 2019 which were 66.0 to 83.0%, 80.0 to 83.0% and 84.0 to 85.0% respectively. Similar increasing pattern of sensitivity found in Salmonella paratyphi which was 82.5 to 89.2%, 76.2 to 95.4%, 98.7 to 98.5% respectively. They were also found highly sensitive (>90.0%) to 3rd generation cephalosporin. This study recommends the use of first-line antibiotics as empirical agent of choice in enteric fever as they are still highly sensitive against Salmonella typhi and Salmonella paratyphi.

Topics: Amoxicillin; Anti-Bacterial Agents; Bangladesh; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Retrospective Studies; Salmonella paratyphi A; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Invasive Salmonella infections result in a significant burden of disease including morbidity, mortality, and financial cost in many countries. Besides typhoid fever, the clinical impact of non-typhoid Salmonella infections is increasingly recognized with the improvement of laboratory detection capacity and techniques. A retrospective multicenter study was conducted to analyze the clinical profiles and antimicrobial resistance patterns of invasive Salmonella infections in hospitalized children in China during 2016-2018. A total of 130 children with invasive Salmonella infections were included with the median age of 12 months (range: 1-144 months). Seventy-nine percent of cases occurred between May and October. Pneumonia was the most common comorbidity in 33 (25.4%) patients. Meningitis and septic arthritis caused by nontyphoidal Salmonella (NTS) infections occurred in 12 (9.2%) patients and 5 (3.8%) patients. Patients < 12 months (OR: 16.04) and with septic shock (OR: 23.4), vomit (OR: 13.33), convulsion (OR: 15.86), C-reactive protein (CRP) ≥ 40 g/L (OR: 5.56), and a higher level of procalcitonin (PCT) (OR: 1.05) on admission were statistically associated to an increased risk of developing meningitis. Compared to 114 patients with NTS infections, 16 patients with typhoid fever presented with higher levels of CRP and PCT (P < 0.05). The rates of resistance to ampicillin, sulfamethoxazole/trimethoprim, ciprofloxacin, and ceftriaxone among Salmonella Typhi and NTS isolates were 50% vs 57.3%, 9.1% vs 24.8%, 0% vs 11.2%, and 0% vs 9.9%, respectively. NTS has been the major cause of invasive Salmonella infections in Chinese children and can result in severe diseases. Antimicrobial resistance among NTS was more common.

Topics: Ampicillin; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Child; Child, Preschool; China; Ciprofloxacin; Drug Resistance, Bacterial; Humans; Infant; Microbial Sensitivity Tests; Procalcitonin; Salmonella; Salmonella Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Child; China; Female; Goats; Humans; Milk; Raw Foods; Rifampin; Salmonella typhi; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Salmonellosis remains an important public health problem globally. The disease is among the leading causes of morbidity and mortality in developing countries that experience poor hygiene and lack of access to clean and safe water. There was an increase in reported cases of Salmonellosis in Njombe Region, Southern Highland of Tanzania between 2015 and 2016 based on clinical diagnosis. Nevertheless, little is known about the factors contributing to the transmission of this disease in the region. This study was conducted to determine the prevalence, antimicrobial susceptibility, and factors associated with Salmonella infection among patients who report gastrointestinal complaints.. A cross-sectional study was conducted from December 2017 to February 2018 among patients with gastrointestinal complaints at Kibena Regional Hospital. Stool samples were submitted for isolation of Salmonella spp. Identification was based on conventional biochemical tests and serotyping to differentiate typhoid and non-typhoid Salmonella (NTS). Antimicrobial susceptibility was performed using the Kirby-Bauer disc diffusion method. Multivariable logistic regression analysis was performed to examine the factors independently associated with Salmonella infection.. The prevalence of Salmonella infection among participants with gastrointestinal complaints was 16.5% (95% CI: 12.7-21.1) of them, 83.7, 95% CI: 70.9-91.5 were NTS while 16.3, 95% CI: 8.5-29.0 were Typhoid Salmonella species. All isolates were sensitive to ceftriaxone and ciprofloxacin, whereas 27.8 and 100% were resistant to co-trimoxazole and ampicillin respectively. The odd of Salmonella infection was fourfold higher among participants with formal employment (AOR 3.8, 95% CI, 1.53-9.40). Use of water from wells/rivers (AOR 2.2, 95% CI, 1.07-4.45), drinking untreated water (AOR 2.6, 95% CI, 1.21-5.48) and often eating at a restaurant (AOR 3.4, 95% CI, 1.28-8.93) had increased odds of Salmonella infection. Likewise, having abdominal pain (AOR 8.5, 95% CI, 1.81-39.78) and diarrhea (AOR 2.3, 95% CI, 1.12-4.68) were independent symptoms that predict Salmonella infection.. There is a high prevalence of Salmonella infection among people who report gastrointestinal complaints and it is clinically predicated by diarhoea and abdominal pain. Employed participants and those eating at restaurant and drinking unsafe water had higher risk of infection. Salmonella spp. causing gastroenteritis has developed resistance to commonly used antibiotics.

Topics: Adolescent; Adult; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Cross-Sectional Studies; Diarrhea; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Female; Gastrointestinal Diseases; Hospitals; Humans; Infant; Male; Middle Aged; Prevalence; Salmonella; Salmonella Infections; Tanzania; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; Young Adult

Salmonella enterica serovar typhi causes one of the most common blood stream infections, the typhoid fever. However, it can cause pyogenic infections involving different sites as well. Extensively drug resistant (XDR) strains of Salmonella typhi are resistant to all first line anti-typhoidal drugs (chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole) as well as ciprofloxacin and ceftriaxone. XDR-strains were first reported from Pakistan in 2016, and since then the strains have been spreading. These XDR Salmonella cases not only pose a therapeutic challenge but also predispose to complications as a result of prolonged illness and delayed treatment. Here, we report a case of superficial thrombophlebitis at intravenous cannula site in a 49-year male, who was being treated for XDR-typhoid fever. To the best of our knowledge, thrombophlebitis of a superficial vein is an unusual complication of Salmonella typhi, not previously reported in literature. Key Words: Bacteremia, Thrombophlebitis, Extensively drug-resistant, Typhoid fever, Salmonella typhi.

Topics: Anti-Bacterial Agents; Humans; Male; Microbial Sensitivity Tests; Pakistan; Salmonella typhi; Thrombophlebitis; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Typhoid fever remains a public health concern in developing countries especially among the poor who live in informal settlements devoid of proper sanitation and clean water supply. In addition antimicrobial resistance poses a major challenge in management of the disease. This study assessed the antimicrobial susceptibility patterns of Salmonella enterica serotype Typhi (S. Typhi) isolated from typhoid fever cases (2004-2007).. A cross sectional study was conducted on 144 archived S. Typhi isolates (2004-2007) tested against 11 antimicrobial agents by quality controlled disk diffusion technique. Isolates resistant to ampicillin, chloramphenicol, and cotrimoxazole were considered Multidrug resistant (MDR). Thirty MDR isolates were selected randomly and further tested using minimum inhibitory concentration (MIC) E-test.. Sixteen percent (23/144) of the isolates were susceptible to all the antibiotics tested while 68% were resistant to three or more of the 11 antibiotics tested. The isolates showed a high susceptibility to ceftriaxone (94%) and gentamicin (97%). A high percentage of resistance was observed for the conventional first-line antibiotics; ampicillin (72%), chloramphenicol (72%), and cotrimoxazole (70%). Sixty-nine percent of the isolates (100/144) showed reduced susceptibility to ciprofloxacin. All the 30 (100%) isolates selected for MIC test were susceptible to amoxicillin-clavulanic acid. All except one of the 30 isolates were susceptible to ceftriaxone while majority 21 (70%) recorded an intermediate susceptibility to ciprofloxacin with MIC of 0.12-0.5 μg/mL.. A large proportion of S. Typhi isolates were MDR and also showed reduced susceptibility to ciprofloxacin. Fluoroquinolone resistance is emerging and this may pose a challenge in treatment of typhoid in future. There is need for routine surveillance to monitor this phenotype in clinical settings.

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Chloramphenicol; Ciprofloxacin; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Fluoroquinolones; Humans; Kenya; Microbial Sensitivity Tests; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Invasive non-typhoidal Salmonella (iNTS) infections are now a well-described cause of morbidity and mortality in children and HIV-infected adults in sub-Saharan Africa. In contrast, the epidemiology and clinical manifestations of iNTS disease in Asia are not well documented. We retrospectively identified >100 cases of iNTS infections in an infectious disease hospital in Southern Vietnam between 2008 and 2013. Clinical records were accessed to evaluate demographic and clinical factors associated with iNTS infection and to identify risk factors associated with death. Multi-locus sequence typing and antimicrobial susceptibility testing was performed on all organisms. Of 102 iNTS patients, 71% were HIV-infected, >90% were adults, 71% were male and 33% reported intravenous drug use. Twenty-six/92 (28%) patients with a known outcome died; HIV infection was significantly associated with death (p = 0.039). S. Enteritidis (Sequence Types (ST)11) (48%, 43/89) and S. Typhimurium (ST19, 34 and 1544) (26%, 23/89) were the most commonly identified serovars; S. Typhimurium was significantly more common in HIV-infected individuals (p = 0.003). Isolates from HIV-infected patients were more likely to exhibit reduced susceptibility against trimethoprim-sulfamethoxazole than HIV-negative patients (p = 0.037). We conclude that iNTS disease is a severe infection in Vietnam with a high mortality rate. As in sub-Saharan Africa, HIV infection was a risk factor for death, with the majority of the burden in this population found in HIV-infected adult men.

Topics: Adult; Aged; Anti-Infective Agents; Ceftriaxone; Drug Therapy, Combination; Female; Fluoroquinolones; HIV Infections; Hospitals; Humans; Logistic Models; Male; Middle Aged; Multilocus Sequence Typing; Multivariate Analysis; Retrospective Studies; Salmonella enterica; Salmonella Infections; Serogroup; Sex Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; Vietnam

A woman aged 20 years presented with fever and no localising signs. She was treated with cotrimoxazole and the subsequent blood culture was positive for Salmonella typhi (S. typhi), which was resistant to fluoroquinolones but susceptible to cotrimoxazole. Genotyping identified an FQ-R subclade of H58 S. typhi Fever clearance time was 4 days after starting the antibiotics, and no relapses were noted on 2 months of follow-up. This inexpensive, well-known and easily available antimicrobial could be suitably redeployed for fluoroquinolone-resistant enteric fever in South Asia.

Topics: Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Female; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; Young Adult

Salmonella enterica serovars Typhi and Paratyphi are predominantly known to cause enteric fever. Multidrug resistance in S. Tphi and S. Paratyphi has emerged as a cause of concern. This study was done to evaluate status in antimicrobial susceptibility patterns of Salmonella enterica serovar Typhi (S. Typhi) and S. Paratyphi obtained from blood culture in a tertiary care hospital in south India.. Blood isolates of Salmonella species over a two year period between May 2009 and June 2011 were studied. A total of 322 isolates of Salmonella species were tested for antimicrobial susceptibility by Kirby-Bauer disc diffusion method. The MIC of ciprofloxacin was obtained by E-test, and azithromycin MIC was confirmed by agar dilution method for a limited number of isolates.. Of the total of 322 isolates studied, 186 (57.8%) were S. Typhi, 134 (41.6%) were S. Paratyphi A, and two were S. Paratyphi B. Of these, 44(13.66%) were resistant to ciprofloxacin (MIC <0.50 μg/ml) and 296 (91.9%) were nalidixic acid resistant. Of these 296 nalidixic acid resistant isolates, 278 (94%) were susceptible to ciprofloxacin by MIC criteria (<0.5 μg/ml). Of the 262 isolates tested for azithromycin sensitivity, only 120 (46%) were susceptible, whereas 81 (31%) were resistant and 55 (21%) showed intermediate susceptibility. Of the isolates, 322 (90%) were susceptible to ampicillin and (95%) were susceptible to co-trimoxazole. However, all the isolates were susceptible to chloramphenicol and ceftriaxone.. Nalidixic acid resistance screening is not a reliable surrogate indicator of ciprofloxacin resistance. Ciprofloxacin MIC should to be routinely done. Azithromycin resistance appears to be emerging. However, isolates showed a high degree of susceptibility to ampicillin, co-trimoxazole and chloramphenicol. Thus, antibiotics like ampicillin and co-trimoxazole may once again be useful for the management of enteric fever in southern India.

Topics: Ampicillin; Chloramphenicol; Ciprofloxacin; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Humans; India; Microbial Sensitivity Tests; Nalidixic Acid; Salmonella paratyphi A; Salmonella typhi; Tertiary Healthcare; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Typhoid fever is a food- and water-borne disease, caused by Salmonella enterica serovar Typhi, responsible for high rates of morbidity and mortality in developing countries. Typhoid is also a public health problem in Algeria. Antimicrobial susceptibility surveillance must be applied to prevent the emergence of multidrug resistant strains.. We studied the incidence of S. enterica serovar Typhi isolated from blood cultures in the Ain M'lila public hospital (Algeria), between 2005 and 2008. Blood cultures were performed in the febrile stage of infection and positive samples were identified by biochemical and antigenic tests. Susceptibility to ampicillin, cotrimoxazole, chloramphenicol and nalidixic acid was tested by antibiogram.. One hundred and seventy-eight strains were isolated from blood cultures between 2005 and 2008. They were all susceptible to the antibiotics tested.. Typhoid fever incidence has decreased in Algeria. In our region, it comes by outbreaks during the summer season, with no sporadic cases between the peaks. In our study, S. enterica serovar Typhi was still susceptible to antimicrobials despite the worldwide emergence of multidrug resistant strains.. A regular surveillance of Salmonella typhi antibiotic susceptibility is mandatory.

Topics: Algeria; Ampicillin; Anti-Bacterial Agents; Bacteremia; Catchment Area, Health; Chloramphenicol; Developing Countries; Disk Diffusion Antimicrobial Tests; Drug Resistance, Microbial; Drug Resistance, Multiple, Bacterial; Hospitals, Public; Humans; Nalidixic Acid; Retrospective Studies; Salmonella typhi; Seasons; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Amoxicillin; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Early Diagnosis; Gastrointestinal Hemorrhage; Humans; Prognosis; Risk Assessment; Severity of Illness Index; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Adolescent; Bacteremia; Bacterial Proteins; Campylobacter Infections; Campylobacter jejuni; DNA Gyrase; Drug Resistance, Microbial; Gastroenteritis; Humans; Male; Mutation, Missense; Nalidixic Acid; Pakistan; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

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

The objective of the present study is to evaluate the clinical profile and pattern of various drugs used in the treatment of typhoid fever. A retrospective analysis of adult patients suffering from typhoid fever was done at Kasturba Medical College hospital, Attavar during the year 1999-2001. Diagnosis of patients was based on clinical features, widal test and blood culture. The sensitivity pattern of isolates from blood culture was recorded. The mode of presentation, clinical course, treatment history, laboratory investigations reports, antibiotic administered, response to therapy and the complications were recorded. Total number of 44 cases of typhoid fever were studied. Out of these 21(47.7%) were males and 23(52.3%) were females. Average age of presentation was 23.9 years. Average duration of hospital stay was 10.8 days. Fever was present in all patients. Resistance of S. typhi to amoxicillin, chloramphenicol, ampicillin and co-trimoxazole were significantly high. Ciprofloxacin also showed resistance in 18.1% of cases. Sensitivity to cephalosporin was 100% in our study. Ciprofloxacin was the most commonly used antibiotic in our study (23 patients). Chloramphenicol alone was used in 2 patients and in 3 patients it was given after 6 days of ciprofloxacin treatment. Third generation cephalosporins (ceftriaxone) alone were used in 16 patients. Indiscriminate use of drugs in typhoid fever should be discouraged. Appropriate antibiotic as indicated by sensitivity tests should be employed to prevent the development of resistant strains of S. typhi.

Topics: Adult; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Cephalosporins; Chloramphenicol; Ciprofloxacin; Drug Resistance, Bacterial; Female; Hospitals, County; Hospitals, Teaching; Humans; Male; Microbial Sensitivity Tests; Retrospective Studies; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

The purpose of this study was to investigate the antibiotic resistance and clonal lineage of serogroup B Salmonella isolated from patients suspected of suffering from enteric fever in Accra, Ghana.. Serogroup B Salmonella were isolated from blood (n=28), cerebral spinal fluid (CSF) (n=1), or urine (n=2), and identified based on standard biochemical testing and agglutinating antisera. Isolates were examined for their susceptibility to ampicillin, chloramphenicol, tetracycline and trimethoprim-sulfamethoxazole. Most of the isolates could be classified as multiple-drug resistant. Furthermore, the genetic location of resistance genes was shown to be on conjugative plasmids. Genetic fingerprinting by plasmid profiling, enterobacterial repetitive intergenic consensus (ERIC)-PCR, and repetitive element (REP)-PCR were performed to determine the diversity among the isolates. Plasmid profiling discriminated five unique groupings, while ERIC-PCR and REP-PCR resulted in two and three groupings, respectively.. A high rate of antibiotic resistance was associated with the Salmonella isolates and the genes responsible for the resistance are located on conjugative plasmids. Also, there appears to be minimal diversity associated with the isolates.. As a result of the increasing antibiotic resistance among bacteria of all genera, surveys to monitor microbial populations are critical to determine the extent of the problem. The inability to treat many infectious diseases with current antibiotic regimens should prompt the medical community to be more prudent with its antibiotic use.

Topics: Ampicillin Resistance; Anti-Bacterial Agents; Chloramphenicol Resistance; Conjugation, Genetic; DNA Fingerprinting; DNA, Bacterial; Drug Resistance, Bacterial; Genotype; Ghana; Humans; Microbial Sensitivity Tests; Phenotype; Polymerase Chain Reaction; Salmonella typhi; Tetracycline Resistance; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Amoxicillin; Anti-Bacterial Agents; Chloramphenicol; Drug Resistance, Multiple; Humans; India; Retrospective Studies; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Ofloxacin has been successfully used in the treatment of typhoid fever and Salmonella infectious of adults for many years. However, it has rarely been tried for the typhoid fever of children. In the present study, the therapeutic efficacy of ofloxacin in the treatment of typhoid fever in children was compared to that of co-trimoxazole. Out of 41 patients with bacteriologically documented typhoid fever, those with co-trimoxazole-resistant strains received 20 mg/kg ofloxacin twice daily for 10 days, and those with co-trimoxazole-susceptible bacteria were given 60 mg/kg co-trimoxazole twice daily for 10 days. Both groups were compared according to the clinical variables (apyrexia, resolution of gastrointestinal, central nervous system reactions and articular symptoms) and the time when cultures became negative. All patients in both groups were cured without relapse. Apyrexia, resolution of gastrointestinal, central nervous system reactions and articular symptoms were obtained in a significantly shorter time with ofloxacin than with co-trimoxazole (P < 0.05). The interval between onset of therapy and the time when cultures became negative was significantly shorter in the ofloxacin group than in the co-trimoxazole group (P = 0.005). Ofloxacin seems to be a good alternative in the treatment of typhoid fever caused by co-trimoxazole resistant salmonellae in children aged less than 16 years. It is well tolerated by the patients and it causes no side effects with short-term usage.

Topics: Anti-Bacterial Agents; Child; Female; Humans; Male; Ofloxacin; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Ampicillin; Anti-Bacterial Agents; Chloramphenicol; Drug Resistance, Microbial; Drug Resistance, Multiple; Humans; Salmonella typhi; Species Specificity; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Drug Sensitivity of Salmonella typhi isolated from 30 blood culture positive cases of typhoid fever who presented between Nov. '93 to Aug. '94 was tested to determine their in vitro susceptibility to various antimicrobiols. 56.6% showed resistance to chloramphenicol, 70% to amoxycillin, 50% to amikacin, 43.3% to gentamycin, 40% to ampicillin, 33.3% to cotrimoxazole, 30% to cephalexin and very low resistance (6.6% each) to ceftriaxone and cefotaxime. All the 30 cases were sensitive to ciprofloxacin and ofloxacin. 17 chloramphenicol resistant typhoid cases in whom chloramphenicol was initially started failed to respond to this drug even after 4-5 days therapy, indicating that in vivo response matched with the in vitro sensitivity. Clinical response to ciprofloxacin, whether given initially or following chloramphenicol failure was prompt and satisfactory. Ciprofloxacin thus appears to be a good choice in such cases.

Topics: Adolescent; Adult; Aminoglycosides; Ampicillin Resistance; Child; Chloramphenicol Resistance; Ciprofloxacin; Drug Resistance, Multiple; Female; Humans; India; Male; Microbial Sensitivity Tests; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Between January and July 1994, a prospective study of bacteraemia in 692 patients with fever without localizing signs was undertaken at the Quetta Military Hospital in Baluchistan, Pakistan. Salmonella spp. were isolated from 76 (11%) of the patients; 62 had S. typhi and 14 had S. paratyphi A. Significantly more isolations of S. typhi were made in the hot dry months of May and June than in the earlier months. Although multi-drug resistance (to chloramphenicol ampicillin and cotrimoxazole) was detected in 43 (69%) of the S. typhi isolates, it was not found in any of the S. paratyphi A. Defervescence of patients with chloramphenicol-sensitive S. typhi took 7-10 days of chloramphenicol therapy. In contrast, most (91%) of the patients infected with multi-drug resistant S. typhi who were treated with fluoroquinolones achieved defervescence in 1-3 days; the remainder took 4-6 days.

Topics: Adolescent; Adult; Ampicillin Resistance; Anti-Bacterial Agents; Anti-Infective Agents; Child; Child, Preschool; Chloramphenicol; Chloramphenicol Resistance; Drug Resistance, Multiple; Fluoroquinolones; Humans; Infant; Pakistan; Prospective Studies; Salmonella typhi; Seasons; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

We report a case of 25 year old man who presented with a febrile illness and bilateral lower chest pain a pain in the left hypochondrium with fever and weight loss; investigations revealed a left sided empyema. The cause of the empyema was confirmed following the isolation in the pleural pus of Salmonella typhi. There was also a mass in the left hypochondrium which was shown on ultrasound to be a splenic abscess. After antibiotic therapy with Cotrimoxazole, repeated pleural aspirates and physiotherapy, there was a satisfactory outcome and the pleural effusion dried up and there was a significant reduction in the volume of the splenic abscess. In the light of their observations, the authors report the rare presentation of empyemas due to Salmonella typhi, the late presentation during the course of the third septenaire and the often favourable outcome under general antibiotic therapy associated with pleural aspirates to evacuate the pus and respiratory physiotherapy.

Topics: Abscess; Adult; Anti-Bacterial Agents; Empyema, Pleural; Humans; Male; Respiratory Therapy; Salmonella typhi; Splenic Diseases; Suction; Trimethoprim, Sulfamethoxazole Drug Combination; 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

An 8-year old girl was infected for a second time with Salmonella typhi by contact with her grandmother, a known typhoid carrier. The S. typhi from both patient and grandmother had closely related genomic pulsed field gel electrophoresis patterns that differed from epidemiologically unrelated strains. The girl responded well to a 14-day course of oral trimethoprimsulfamethoxazole. The grandmother was treated successfully with a 28-day regimen of oral ciprofloxacin. Typhoid fever remains an endemic disease in the United States, largely because of recognized chronic stool carriers. Most of these carriers had typhoid in the preantibiotic era and remain potential sources of disease when they provide meals for others, not uncommonly grandchildren. The importance of this "grandmother" connection to endemic typhoid fever is reviewed, as is the potential use of pulsed field gel electrophoresis pattern analysis for comparison of strains of S. typhi.

Topics: Aged; Carrier State; Child; Ciprofloxacin; Disease Transmission, Infectious; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Feces; Female; Humans; Polymorphism, Restriction Fragment Length; Recurrence; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; United States

Salmonella infections in man can be divided in five clinical groups: enteric fever, septicaemia without localization, focal disease, gastroenteritis and the carrier state. Salmonella typhi is mostly associated with enteric fever and the carrier state. Bone infections due to S. typhi have been reported relatively seldom. They usually occur as the result of metastatic spread during septicaemia or, more rarely, after direct inoculation. Two patients with S. typhi osteomyelitis of the forearm without evidence of a primary infection or direct inoculation are presented here.

Topics: Adult; Cefotaxime; Forearm; Humans; Male; Ofloxacin; Osteomyelitis; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; Wrist

Topics: Ampicillin; Child; Chloramphenicol; Drug Resistance, Microbial; Egypt; Female; Humans; Male; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

The in vitro activities of enoxacin, lomefloxacin, norfloxacin, ofloxacin, and pefloxacin against 274 strains of Salmonella typhi isolated from suspected typhoid fever patients (137 multi-resistant strains and 137 strains sensitive to chloramphenicol, ampicillin and/or co-trimoxazole) were determined using disk diffusion and agar dilution techniques. In vitro, enoxacin was active against all tested strains with a MIC90 and inhibition zone size against multi-resistant strains of 0.12 mg/l and 34 mm diameter, respectively. Similar results were found with the other fluoroquinolones. Enoxacin and other fluoroquinolones may be the therapy of choice in cases of typhoid fever caused by organisms resistant to the standard therapy, chloramphenicol.

Topics: Ampicillin; Anti-Infective Agents; Chloramphenicol; Drug Resistance, Microbial; Enoxacin; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Norfloxacin; Pefloxacin; Quinolones; Salmonella typhi; Species Specificity; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

A typhoid patient was infected with a fully-sensitive, plasmidless strain of Salmonella typhi which acquired resistance to kanamycin, sulfamethoxazole and trimethoprim during cotrimoxazole therapy. The resistant post-treatment strain harboured 4 plasmids of 62, 4.1, 3.8 and 3.0 Md in size. Kanamycin-, sulfamethoxazole- and trimethoprim-resistance were borne on a transferable 62 Md plasmid which was compatible with groups FI, FIme, FII, FIV, H1, H2, B, I1, I2, J, K, M, N, T, X, W and P. Sulfamethoxazole-resistance was also borne on the 4.1 Md plasmid. The 3.8 Md plasmid was not transferable; the 3.0 Md plasmid was transferable but did not confer antibiotic resistance. Excluding the strain described here, only 5 out of 35 other S typhi isolates contained plasmids. This is the first report of trimethoprim-resistant S typhi in Hong Kong.

Topics: Adult; Drug Resistance, Microbial; Humans; Kanamycin Resistance; Male; Salmonella typhi; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Ampicillin; Ampicillin Resistance; Chloramphenicol; Chloramphenicol Resistance; Developing Countries; Disease Outbreaks; Drug Resistance, Microbial; Humans; India; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Forty six blood culture positive cases were studied during the current outbreak of multidrug resistant typhoid fever (MRTF). The present outbreak was caused by E1 phage type and organisms were resistant to all commonly used drugs for the treatment of typhoid fever, viz., chloramphenicol (78%), co-trimoxazole (76%) and ampicillin (68%). Treatment failures with chloramphenicol (45.5%) corroborated well with in vitro resistance. No treatment failure was seen with chloramphenicol and ceftriaxone, when these drugs were used in cases infected with sensitive strains. Among the alternative drugs used in cases with in vitro sensitivity, successful clinical response was seen with ceftriaxone (4/4) and cefotaxime (8/9) as compared to cephalexin (3/5) or a combination of cephalexin and furazolidone (9/12).

Topics: Ampicillin Resistance; Anti-Bacterial Agents; Child; Chloramphenicol Resistance; Disease Outbreaks; Drug Resistance, Microbial; Humans; In Vitro Techniques; India; Salmonella Phages; Salmonella typhi; Tetracycline Resistance; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; Urban Population

Between September 1989 and February 1991, strains of S. typhi showing multiple drug resistance were isolated from blood cultures of patients with typhoid fever. A total of 283 isolates were obtained over a period of 18 months. Forty four (11%) of these isolates were resistant to chloramphenicol, ampicillin, co-trimoxazole and tetracycline, the first three being drugs currently used in treating typhoid fever. Forty of the 44 multi-resistant strains tested showed transfer of resistance 'en block' to recipient Escherichia coli K 12 (J62-2). All 44 multi-resistant strains were sensitive to ciprofloxacin and ofloxacin. Since the resistance is plasmid-mediated, the problem is likely to get aggravated.

Topics: Ampicillin Resistance; Chloramphenicol Resistance; Drug Resistance, Microbial; Humans; R Factors; Salmonella typhi; Tetracycline Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Typhoid fever caused by Salmonella typhi remains endemic to many parts of South Africa, including Natal and KwaZulu, Northern Transvaal and the Transkei. Until recently, the majority of S. typhi isolates from South Africa have remained susceptible to ampicillin/amoxycillin and chloramphenicol, and only three cases of typhoid due to multi-antibiotic resistant strains of S. typhi have been documented. Ampicillin/amoxycillin and chloramphenicol are, therefore, still recommended as first line therapy for patients with typhoid fever in this country. We describe a cluster of six cases of typhoid caused by S. typhi that was resistant to ampicillin, chloramphenicol and trimethoprim-sulphamethoxazole. All these patients presented over a 3-month period; the patients were from three adjacent districts in the Northern Natal area of South Africa. The high rate of intestinal perforation (two of six) was a direct consequence of inappropriate antibiotic treatment. Failure of surgical intervention, renal impairment as well as delay in starting appropriate antibiotic treatment were factors contributing to the high mortality (three of six). The good clinical outcome in the remaining three patients probably resulted from treatment with appropriate antibiotics; however, mild disease in two of these patients may have been a contributing factor. All isolates showed high minimal inhibitory concentrations (MIC) of greater than or equal to 256 micrograms/ml to ampicillin, chloramphenicol and trimethoprim-sulphamethoxazole. The isolates were all highly sensitive to the third generation cephalosporins (MIC less than or equal to 0.06 micrograms/ml) and quinolones (MIC less than or equal to 0.03 micrograms/ml). Conjugation studies suggest a genetic transfer of resistance, probably plasmid mediated. The presence of beta-lactamase and chloramphenicol acetyl transferase enzymes in all six isolates tested would account for the resistance to ampicillin and chloramphenicol respectively. The transfer of such plasmids to erstwhile sensitive strains could conceivably occur in this typhoid-endemic area, where sanitary conditions are poor and living conditions crowded, thus further exacerbating the problem. It is recommended that in areas where such multiresistant strains are encountered, the third generation cephalosporins or quinolones be used as empiric therapy for typhoid fever.

Topics: Adult; Ampicillin; Child; Child, Preschool; Chloramphenicol; Disease Outbreaks; Drug Resistance, Microbial; Female; Humans; Male; Salmonella typhi; South Africa; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Treatment of children with infections caused by Salmonella typhi strains resistant to the commonly used oral antimicrobials is a special problem. As children cannot be treated with quinolones, there is no form of oral therapy. Third generation cephalosporins, which have been shown to be effective against typhoid caused by ampicillin sensitive strains of S. typhi were effective against typhoid caused by ampicillin, chloramphenicol and sulfamethoxazole/trimethoprim-resistant strains. We treated 28 children with ceftriaxone and 8 with cefotaxime. We found ceftriaxone to be more effective than cefotaxime with significantly lower relapse rate. Antibiotic therapy of 19 other children, initially treated in a similar manner, was altered for ease of therapy or due to poor response to therapy. The high cost of this parenteral therapy and the problems in its delivery point to the need for safe, effective oral therapy.

Topics: Adolescent; Ampicillin Resistance; Aztreonam; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol Resistance; Drug Resistance, Microbial; Humans; Infant; Infant, Newborn; Ofloxacin; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Ampicillin; Child; Chloramphenicol; Chloramphenicol Resistance; Drug Resistance, Microbial; Humans; In Vitro Techniques; India; R Factors; Salmonella typhi; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Multiple drug resistant Salmonella typhi infection was observed in thirty five recent cases among forty eight children with bacteriologically proven enteric fever. Incidence of complications such as shock, myocarditis, encephalopathy and paralytic ileus was higher among these. A combination of cephalexin and gentamicin was successfully used in the management of these children.

Topics: Amoxicillin; Cephalexin; Child; Child, Preschool; Chloramphenicol; Chloramphenicol Resistance; Drug Resistance, Microbial; Female; Gentamicins; Humans; In Vitro Techniques; India; Male; Salmonella typhi; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Adolescent; Amoxicillin; Ampicillin; Child; Child, Preschool; Chloramphenicol; Chloramphenicol Resistance; Ciprofloxacin; Drug Resistance, Microbial; Female; Humans; India; Male; R Factors; Salmonella typhi; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Ampicillin; Cefotaxime; Child; Child, Preschool; Chloramphenicol; Chloramphenicol Resistance; Ciprofloxacin; Drug Resistance, Microbial; Female; Humans; India; Male; Salmonella typhi; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

A 14 year old boy developed the syndrome of Bickerstaff's brainstem encephalitis during the course of bacteriologically proved typhoid fever. The clinical course and the results of various neurological investigations are detailed. This report adds a further manifestation to the published neuropsychiatric complications of typhoid fever.

Topics: Adolescent; Ampicillin; Drug Therapy, Combination; Electroencephalography; Encephalitis; Humans; Male; Salmonella typhi; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Experience with typhoid fever in 111 children over a 5-year period was reviewed. There were 66 boys and 45 girls, ranging in age from 1 to 11.5 years. The symptoms of typhoid fever were quite non-specific. Fever was the most common presenting symptom (in 98.3%). Other common presenting features were diarrhoea (25.7%), constipation (22%), vomiting (21.1%), cough (25%), abdominal pain (27.5%), headache (9.2%), epistaxis, meningism and convulsions. Rose spots were detected in 20% of cases, occurring mainly during the first 2 weeks of illness. Significant Widal reactions were present in 84.7% of cases. Blood and stool cultures were positive in 57% and 44% of cases, respectively. Peripheral blood white cell counts were not found to be of great diagnostic value. Chloramphenicol remained the drug of choice in the treatment of typhoid fever. It was more effective than ampicillin or co-trimoxazole. Complications were uncommon, occurring in only two patients. There were two deaths; both were admitted late and in moribund state. Early diagnosis and treatment is vital in typhoid fever and, as the presenting features are non-specific, a high index of suspicion is required.

Topics: Ampicillin; Anti-Infective Agents; Child; Child, Preschool; Chloramphenicol; Drug Combinations; Female; Hong Kong; Humans; Infant; Male; Retrospective Studies; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

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; Chloramphenicol; Drug Combinations; Drug Therapy, Combination; Female; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Ninety-four patients with Salmonella typhi infection hospitalized and treatment. Widal test results, blood cultures, stool cultures and physical examination findings were admitted infection criteria. Ampicillin used 100 mg/kg/day four divided dose in 52 patients, chloramphenicol used 2g/day four divided dose in 28 patients and TMP-SMZ 160-800 mg used bid in 14 patients. All of the treatments applied for 2 weeks. Ampicillin 92.30%, chloramphenicol 82.15% and TMP-SMZ 85.71% were found success. Fever dropped in normal degrees 3.43 +/- 1.71 days in ampicillin group, 3.47 +/- 1.13 days in chloramphenicol group and 3 +/- 1.41 days in TMP-SMZ group.

Topics: Adolescent; Adult; Ampicillin; Anti-Infective Agents; Chloramphenicol; Drug Administration Schedule; Drug Combinations; Female; Humans; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

There are few reports of transplacental infection by Salmonella typhi. A case of a primagravida at 26 weeks' gestation with severe S typhi gastroenteritis, sepsis, and disseminated intravascular coagulation is presented. Shortly after institution of antibiotic therapy, she spontaneously aborted a previable infant. Amniotic fluid was turbid and subsequently grew S typhi.

Topics: Abortion, Spontaneous; Adult; Amniotic Fluid; Ampicillin; Clindamycin; Disseminated Intravascular Coagulation; Drug Combinations; Drug Therapy, Combination; Female; Gentamicins; Humans; Pregnancy; Pregnancy Complications, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Typhoid fever is still a major problem in developing Third World countries where socioeconomic conditions and standards of hygiene are still well below standard. Prophylaxis is far from satisfactory. However, recent developments using live oral vaccines are encouraging. Specific treatment for the disease consists of chloramphenicol or co-trimoxazole; amoxycillin and ampicillin are inferior agents but are of value in several situations because their potential toxic effects are less marked. Most other agents also have drawbacks or are relatively ineffective. In the severely toxic patient, corticosteroids seem to affect prognosis favourably. Of the many other acute complications of typhoid fever, ileal perforation is the most serious; there is still controversy concerning the respective roles of conservative and surgical management, but it is clear that individual cases must be assessed on their merit. Amoxycillin, because it is very rapidly absorbed and produces very high blood concentrations, is probably the best antibiotic for the carrier state.

Topics: Adrenal Cortex Hormones; Amdinocillin; Amdinocillin Pivoxil; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Carrier State; Chloramphenicol; Drug Combinations; Furazolidone; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; Typhoid-Paratyphoid Vaccines; Water-Electrolyte Balance

Topics: Amoxicillin; Chloramphenicol; Drug Combinations; Drug Evaluation; Female; Humans; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Ethical and medical problems arise with typhoid infections in pregnant women. In spite of preventive care, this disease is still present and dangerous. Thirty such cases have been studied in our Clinic where treatment was carried out with four different drug regimens: chloramphenicol, ampicillin, these two drugs in association, and cotrimoxazole. On the whole the therapy was proven efficient: the infection was resolved and pregnancy continued. Only three cases of abortion and two malformed babies were observed. Aspects of reciprocal interference between infection and pregnancy are discussed and the choice of the most effective therapy is evaluated.

Topics: Adolescent; Adult; Ampicillin; Chloramphenicol; Drug Combinations; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Twenty-six patients with enteric fever treated with amdinocillin and/or its pivaloyloxymethyl ester in 1975 to 1978 were compared with 21 patients with enteric fever treated with trimethoprim-sulfamethoxazole in 1972 to 1974. Diagnosis was based on clinical illness and isolation of Salmonella typhi or S. paratyphi A/B from blood cultures or stool cultures. The dosage of pivamdinocillin in adults was 400 to 800 mg, every 6 hours, for 10 to 16 days; dosage in children was half this amount for 11 to 15 days. Of the 21 patients treated with trimethoprim-sulfamethoxazole, 18 (86 percent) showed a satisfactory clinical response; 13 of these 18 had negative stools immediately after therapy, and two more were negative at the time of discharge (total: 83 percent). Mean hospital stay of these patients was 34.5 days. Of the 26 patients treated with amdinocillin, 23 showed a satisfactory clinical response; 20 of those responding clinically were still excreting the causative organism at the end of therapy; seven of the group remained as convalescent patients who continued to excrete the causative organism in feces at the time of discharge. Mean hospital stay was 43 days. The results of initial trials of amdinocillin and ampicillin in combination suggest that such therapy may be preferable to use of amdinocillin alone, although the excretion of the causative organism during convalescence has not been adequately assessed.

Topics: Adolescent; Adult; Amdinocillin; Amdinocillin Pivoxil; Ampicillin; Body Temperature; Child; Drug Combinations; Feces; Female; Humans; Male; Penicillanic Acid; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

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

Topics: Adult; Aged; Ampicillin; Anti-Infective Agents, Urinary; Chloramphenicol; Drug Combinations; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Chloramphenicol is still very effective for acute enteric fever. A literature survey does not confirm the repeated claims of decreasing efficacy over the past 20 years (not taking into account the R factor mediated resistance noted since 1972/73). However, there have been regional variations in the time needed to achieve defervescence under chloramphenicol treatment since the early 1950s. When comparing alternative antimicrobials with chloramphenicol other criteria apart from clinical efficacy have to be considered, namely, influence on the rate of excretion of the organisms and the relapse rate, ease of administration parenterally, toxicity, cost, and the possible occurrence of resistance to Salmonella typhi or S. paratyphi A/B.

Topics: Chloramphenicol; Drug Combinations; Drug Resistance, Microbial; Humans; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Patients with enteric fever confirmed by isolation of Salmonella species from blood culture, were treated with the combination of trimethoprim-sulphamethoxazole (co-trimoxazole). All 133 patients responded well to treatment. The mean defervescence was 2.74 days. No serious side effects were noticed and relapses occurred in the patients during the period of follow up.

Topics: Adolescent; Adult; Drug Combinations; Female; Humans; Jaundice; Malaria; Male; Middle Aged; Sudan; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Topics: Adolescent; Adult; Age Factors; Child; Chloramphenicol; Drug Combinations; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever