title: Multidrug-resistant typhoid in children: presentation and clinical features.
abstract: Typhoid accounts for 8% of pediatric admissions to the Aga Khan University Hospital in Karachi, Pakistan. Over a 4-year period (1986-1989), 355 children had typhoid documented by culture of blood or bone marrow. Strains of Salmonella, resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole accounted for 20% of these cases. Compared with children infected by drug-susceptible strains of Salmonella, children with multiresistant infection were generally sicker at presentation and were more likely to be assessed as appearing "toxic" (P less than .001), as having disseminated intravascular coagulation (P less than .01), and as exhibiting hepatomegaly (P less than .01). The mortality was 4.2% among children with multiresistant infection and 1.4% among those infected with strains susceptible to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole; the higher mortality in the former group was probably due to a longer duration of illness (P less than .05) and to ineffectual oral antimicrobial therapy before hospitalization.
authors.affiliation: Department of Pediatrics, Faculty of Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: Z A
authors.initials: ZA
authors.lastname: Bhutta
authors.forename: S H
authors.initials: SH
authors.lastname: Naqvi
authors.forename: R A
authors.initials: RA
authors.lastname: Razzaq
authors.forename: B J
authors.initials: BJ
authors.lastname: Farooqui
mesh_terms: D000668:Ampicillin Resistance; D002648:Child; D002675:Child, Preschool; D002702:Chloramphenicol Resistance; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012485:Salmonella typhi / Q000187:drug effects*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology*; D014435:Typhoid Fever / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination