title: Resistance Patterns of Typhoid Fever in Children: A Longitudinal Community-Based Study.
abstract: Salmonella typhi and S. paratyphi are important causes of bacteremia in children, especially those from the developing world. There is a lack of standardized treatment protocols for such patients in the literature, and there are also reports of therapeutic failure related to resistance to commonly used antibiotics. We analyzed the epidemiological, clinical, and antimicrobiological sensitivity patterns of disease in patients diagnosed with blood culture-positive typhoid fever over a 6-month period in a tertiary-care pediatric hospital in western India. Data were retrospectively analyzed for all patients with Salmonella isolates on blood culture between January 1 and June 30, 2011 at the Synergy Neonatal and Pediatric Hospital. Susceptibility of isolates to antimicrobials and minimum inhibitory concentrations were determined. Demographic data, symptoms and signs, basic laboratory results, treatment courses, and clinical outcomes were collected from clinical charts. All of the 61 isolates of S. typhi were sensitive to cefepime (fourth-generation cephalosporin), 96% to third-generation cephalosporins, and 95% to quinolones. There was intermediate sensitivity to ampicillin (92%) and chloramphenicol (80%). Notably, azithromycin resistance was observed in 63% of isolates. All patients ultimately made full recoveries. There is an urgent need for large scale, community-based clinical trials to evaluate the effectiveness of different antibiotics in enteric fever. Our antimicrobial susceptibility data suggest that quinolones and third-generation cephalosporins should be used as first-line antimicrobials in enteric fever. Although fourth-generation cephalosporins are useful, we feel their use should be restricted to complicated or resistant cases.
authors.affiliation: 1Division of Neonatal and Pediatric Emergency Medicine, Synergy Neonatal and Pediatric Hospital, Ahmedabad, India; 2GCS Medical College & Hospital, Ahmedabad, India; 3Department of Emergency Medicine (Pediatrics), King Khalid University Hospital, College of Medicine and Dentistry, King Saud University, Riyadh, Saudi Arabia; 4Divisions of Pediatric Emergency Medicine Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Ontario, Canada; and 5Division of Clinical Pharmacology and Toxicology, Ichilov Hospital, University of Tel Aviv, Israel.
authors.forename: Snehal
authors.initials: S
authors.lastname: Vala
authors.forename: Urvesh
authors.initials: U
authors.lastname: Shah
authors.forename: Syed Amir
authors.initials: SA
authors.lastname: Ahmad
authors.forename: Dennis
authors.initials: D
authors.lastname: Scolnik
authors.forename: Miguel
authors.initials: M
authors.lastname: Glatstein
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D006776:Hospitals, Pediatric; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008137:Longitudinal Studies; D008826:Microbial Sensitivity Tests; D010284:Paratyphoid Fever / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D012482:Salmonella paratyphi A / Q000187:drug effects* / Q000302:isolation & purification; D012485:Salmonella typhi / Q000187:drug effects* / Q000302:isolation & purification; D014435:Typhoid Fever / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents