A 6-year study on the treatment of typhoid fever in children from India – Are we running out of options?

Abstract

Background: Typhoid fever remains to be a major public health problem even in the present advanced era. With the emerging antimicrobial resistance in typhoid fever, there are very few options to treat typhoid fever. As there is no new antibiotic in the horizon, there is a need to know the actual use of available antibiotics. So, to know the actual practices of antibiotics in the treatment of typhoid fever we designed the current study in a tertiary care hospital. Methods and materials: All the children who met the case definition including clinical and laboratory parameters of 38-degree Fahrenheit fever lasted for at least three days were included in the study. This was an observational study. In the hospitalized patients the antibiotics given were measured as days of therapy per 1000 patient days and in OPD as per the antibiotic were prescribed. Results: Out of total 167 children who met the inclusion criteria, 42 were admitted while125 were treated from OPD. Based on antimicrobial susceptibility ceftriaxone was given to total 37 patients with mean duration of treatment being 6 days. The mean duration of fever was 9.5 days at the time of presentation. Boys constituted 75% and 56% of patients enrolled as in-patients and OPD, respectively. S. Typhi was etiological agent in 68% followed by S. Paratyphi A in 32%. Duration of fever for IgM positive patients was 3–45 days with mean 10.2 days.. An additional antibiotic was needed in 6 patients due to clinical non response. Conclusion: It can be concluded from the present study that ceftriaxone and cefixime form the first line of antibiotic treatment. Although all the isolates were sensitive to ceftriaxone and cefixime but increasing MIC for ceftriaxone is a cause of concern. In our settings use of second antibiotic in case of clinical non response even after 48–72 h of the use of first-line drug needs more study.