title: Multidrug-resistant typhoid fever: a review.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India. drzakisyed@gmail.com
authors.forename: Syed Ahmed
authors.initials: SA
authors.lastname: Zaki
authors.forename: Sunil
authors.initials: S
authors.lastname: Karande
mesh_terms: D000667:Ampicillin / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D002701:Chloramphenicol / Q000494:pharmacology / Q000627:therapeutic use; D003140:Communicable Disease Control / Q000379:methods; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D012485:Salmonella typhi / Q000187:drug effects* / Q000302:isolation & purification; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology / Q000627:therapeutic use; D014435:Typhoid Fever / Q000453:epidemiology* / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D002701:Chloramphenicol; D000667:Ampicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination