[A case of Salmonella enterica serovar typhi with decreased susceptibility to ciprofloxacin].
The use of fluoroquinolone (FQ) as first line therapy for typhoid fever should be reconsidered because of the emergence of Salmonella Typhi and Paratyphi A strains with decreased susceptibility to FQ, mainly from Asia. Relapse can occur when ciprofloxacin MIC is over 0.12 mg/l, as illustrated by our case report. Azithromycin can be used successfully for patients infected with reduced ciprofloxacin susceptibility isolates. Literature review led us to suggest a new therapeutic strategy for uncomplicated typhoid fever, the antibiotic was chosen according to nalidixic acid susceptibility and ciprofloxacin MIC of the strain. High-dose intravenous ceftriaxone (4 g per day) is always efficient in first line therapy. Depending on FQ susceptibility testing results, it is relayed by oral therapy with a FQ (ciprofloxacin 500 mg bid for 7 days) if the isolate has maintained susceptibility, or azithromycin (1 g first day and 500 mg per day, 7 days) if the isolate is resistant to nalidixic acid or has a ciprofloxacin MIC superior to 0.12 mg/l.
Gaborieau
V
V
Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier de Pau, 4 Boulevard Hauterive, 64046 Pau, France. valerie.gaborieau@cegetel.net
Weill
F-X
FX
Marchou
B
B
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D002443:Ceftriaxone / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000494:pharmacology* / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D006801:Humans; D007194:India; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009268:Nalidixic Acid / Q000494:pharmacology; D015242:Ofloxacin / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012008:Recurrence; D012482:Salmonella paratyphi A / Q000187:drug effects; D012485:Salmonella typhi / Q000187:drug effects* / Q000302:isolation & purification; D014195:Travel; D014435:Typhoid Fever / Q000188:drug therapy / Q000382:microbiology*
D000900:Anti-Bacterial Agents; D009268:Nalidixic Acid; D002939:Ciprofloxacin; D002443:Ceftriaxone; D015242:Ofloxacin