Abstract
Multidrug-resistant Salmonella enterica subsp. enterica serovar Typhi (resistant to ampicillin, chloramphenicol and cotrimoxazole), was significantly reduced with the increased usage of fluoroquinolones and azithromycin. This has led to declining multidrug resistance rates in India with increasing ciprofloxacin nonsusceptibility rates and clinical failures due to azithromycin. However, for the available agents such as ceftriaxone, azithromycin and fluoroquinolones, the dose and duration for treatment is undefined. The ongoing clinical trials for typhoid management are expected to recommend the defined dose and duration for better clinical outcome. We made an attempt to summarize the issues in laboratory detection, treatment options and responses, and the concerns in clinical practice seen in the developing countries.
Highlights
This review summarizes the challenges in the laboratory diagnosis of typhoid fever and the current situation of multidrug resistance (MDR) S
Typhi has shown a significant increase and is associated with longer duration of fever defervescence [37,64,80]. This reiterates that fluoroquinolone should not be recommended for empirical treatment of typhoid fever
It is interesting to note that there has been a recent sustained decrease in MDR typhoidal Salmonella isolates in India
Summary
Ceftriaxone (IV) – 2 g 4.8 daily for 14 days Azithromycin – 500 mg daily for the first 7 days. Typhi has shown a significant increase and is associated with longer duration of fever defervescence [37,64,80] This reiterates that fluoroquinolone should not be recommended for empirical treatment of typhoid fever. Greater misuse is expected with availability of this cephalosporin–azithromycin combination, which is worrisome This reiterates that in the context of reduced fluoroquinolone susceptibility, third-generation cephalosporins, such as ceftriaxone/cefixime or azithromycin, are the treatment of choice for treating S. Evidence from the progressing clinical trials (clinicaltrial.gov: NCT02224040, NCT02708992), on cefixime–azithromycin and ceftriaxone–azithromycin FDCs could prove them to be be an effective alternative therapy for the management of quinolone-resistant S. Defined dosage and its significant activity in treating complicated typhoid fever remain uncertain
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