title: Rationale of azithromycin prescribing practices for enteric fever in India.
abstract: OBJECTIVE
  The present study was performed to assess the current susceptibility pattern of blood isolates of Salmonella spp from a super specialty hospital in North India against nalidixic acid, ciprofloxacin and azithromycin and compare the in vitro and in vivo response against azithromycin.
  
  
  METHODS
  We evaluated the minimum inhibitory concentration's (MIC's) of 107 blood isolates of Salmonella spp against nalidixic acid, azithromycin and ciprofloxacin and correlated in vitro and in vivo response of azithromycin from the treatment and discharge summaries from the Hospital Information System (HIS) software.
  
  
  RESULTS
  Among the 107 isolates evaluated, 94 (87.8%) were nalidixic acid-resistant (NAR) Salmonella and 36 were resistant to azithromycin by MIC testing. The MIC 90 value for azithromycin was 24 μg/mL. Among the 57 treatment histories evaluated using the HIS software, 19 (33%) patients had documented clinical non-response to azithromycin which required change of therapy.
  
  
  CONCLUSIONS
  The present study observed a higher MIC 90 values for azithromycin compared to Salmonella isolates from Western studies. There was also a documented clinical non-response against azithromycin. The in vitro and in vivo findings in this study suggest a guarded use of azithromycin for cases of enteric fever in India. The study also augments the reversal of resistance pattern in favour of chloramphenicol, ampicillin and trimethoprim - sulfamethoxazole.
authors.affiliation: Department of Microbiology, UCMS and GTB Hospital, Dilshad Garden, Delhi - 110 095, India. sumit_rai@yahoo.com
authors.forename: S
authors.initials: S
authors.lastname: Rai
authors.forename: S
authors.initials: S
authors.lastname: Jain
authors.forename: K N
authors.initials: KN
authors.lastname: Prasad
authors.forename: U
authors.initials: U
authors.lastname: Ghoshal
authors.forename: T N
authors.initials: TN
authors.lastname: Dhole
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D017963:Azithromycin / Q000494:pharmacology* / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007194:India; D008826:Microbial Sensitivity Tests; D009268:Nalidixic Acid / Q000494:pharmacology / Q000627:therapeutic use; D012485:Salmonella typhi / Q000187:drug effects* / Q000302:isolation & purification*; D014435:Typhoid Fever / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D009268:Nalidixic Acid; D002939:Ciprofloxacin; D017963:Azithromycin