Tags

Type your tag names separated by a space and hit enter

Treatment of enteric fever in children on the basis of current trends of antimicrobial susceptibility of Salmonella enterica serovar typhi and paratyphi A.
Indian J Med Microbiol. 2006 Apr; 24(2):101-6.IJ

Abstract

PURPOSE

Recent reports indicate decreased susceptibility of S. typhi to fluoroquinolones, especially ciprofloxacin. Chloramphenicol has been suggested as first line therapy of enteric fever in many studies. This is a prospective study that describes the trends of antimicrobial susceptibility of S. typhi and S. paratyphi A causing bacteraemia in children and reports therapeutic failure to ciprofloxacin and evaluates the possible use of chloramphenicol, ampicillin, ciprofloxacin and third generation cephalosporins as first line therapy in the treatment of enteric fever in children.

METHODS

The present study was conducted from April 2004 to March 2005 in a superspeciality children hospital at New Delhi. A total of 56 S. typhi and five S. paratyphi A isolates were obtained among the 673 blood cultures performed. Antimicrobial testing was done using disk diffusion technique (NCCLS method) for 13 antimicrobials and MICs were calculated for ampicillin, ciprofloxacin, chloramphenicol and cefotaxime. Analysis of data was done using WHONET software.

RESULTS

All 56 isolates of S. typhi were sensitive to amoxycillin+clavulanate, gentamicin, cefixime, cefotaxime and ceftazidime. Multidrug resistance (MDR, resistance to three drugs) was seen in 22 cases (39%) and resistance to five drugs was seen in 12 cases (21%). Only two isolates were resistant to chloramphenicol (3%). MIC 90 for ampicillin, chloramphenicol, ciprofloxacin and cefotaxime were 1.0 microg/ml, 4.0 microg/ml, 64 microg/ml and 0.125 microg/ml respectively. All S. paratyphi A isolates were sensitive to ampicillin and chloramphenicol and resistant to nalidixic acid. MIC distribution data for chloramphenicol revealed elevated MIC but still in susceptible range.

CONCLUSIONS

There is an urgent need for further clinical studies to evaluate response to chloramphenicol in such cases. Antimicrobial susceptibility data and MIC distribution favour use of ampicillin as a drug of choice for the treatment of enteric fever. Third generation cephalosporins are also useful but their use should be restricted for complicated cases.

Authors+Show Affiliations

Department of Clinical Microbiology, Maulana Azad Medical College and Associated Chacha Nehru Children Hospital, Geeta Colony, New Delhi - 110 031, India. manchandavikas@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16687859

Citation

Manchanda, V, et al. "Treatment of Enteric Fever in Children On the Basis of Current Trends of Antimicrobial Susceptibility of Salmonella Enterica Serovar Typhi and Paratyphi A." Indian Journal of Medical Microbiology, vol. 24, no. 2, 2006, pp. 101-6.
Manchanda V, Bhalla P, Sethi M, et al. Treatment of enteric fever in children on the basis of current trends of antimicrobial susceptibility of Salmonella enterica serovar typhi and paratyphi A. Indian J Med Microbiol. 2006;24(2):101-6.
Manchanda, V., Bhalla, P., Sethi, M., & Sharma, V. K. (2006). Treatment of enteric fever in children on the basis of current trends of antimicrobial susceptibility of Salmonella enterica serovar typhi and paratyphi A. Indian Journal of Medical Microbiology, 24(2), 101-6.
Manchanda V, et al. Treatment of Enteric Fever in Children On the Basis of Current Trends of Antimicrobial Susceptibility of Salmonella Enterica Serovar Typhi and Paratyphi A. Indian J Med Microbiol. 2006;24(2):101-6. PubMed PMID: 16687859.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of enteric fever in children on the basis of current trends of antimicrobial susceptibility of Salmonella enterica serovar typhi and paratyphi A. AU - Manchanda,V, AU - Bhalla,P, AU - Sethi,M, AU - Sharma,V K, PY - 2006/5/12/pubmed PY - 2006/8/4/medline PY - 2006/5/12/entrez SP - 101 EP - 6 JF - Indian journal of medical microbiology JO - Indian J Med Microbiol VL - 24 IS - 2 N2 - PURPOSE: Recent reports indicate decreased susceptibility of S. typhi to fluoroquinolones, especially ciprofloxacin. Chloramphenicol has been suggested as first line therapy of enteric fever in many studies. This is a prospective study that describes the trends of antimicrobial susceptibility of S. typhi and S. paratyphi A causing bacteraemia in children and reports therapeutic failure to ciprofloxacin and evaluates the possible use of chloramphenicol, ampicillin, ciprofloxacin and third generation cephalosporins as first line therapy in the treatment of enteric fever in children. METHODS: The present study was conducted from April 2004 to March 2005 in a superspeciality children hospital at New Delhi. A total of 56 S. typhi and five S. paratyphi A isolates were obtained among the 673 blood cultures performed. Antimicrobial testing was done using disk diffusion technique (NCCLS method) for 13 antimicrobials and MICs were calculated for ampicillin, ciprofloxacin, chloramphenicol and cefotaxime. Analysis of data was done using WHONET software. RESULTS: All 56 isolates of S. typhi were sensitive to amoxycillin+clavulanate, gentamicin, cefixime, cefotaxime and ceftazidime. Multidrug resistance (MDR, resistance to three drugs) was seen in 22 cases (39%) and resistance to five drugs was seen in 12 cases (21%). Only two isolates were resistant to chloramphenicol (3%). MIC 90 for ampicillin, chloramphenicol, ciprofloxacin and cefotaxime were 1.0 microg/ml, 4.0 microg/ml, 64 microg/ml and 0.125 microg/ml respectively. All S. paratyphi A isolates were sensitive to ampicillin and chloramphenicol and resistant to nalidixic acid. MIC distribution data for chloramphenicol revealed elevated MIC but still in susceptible range. CONCLUSIONS: There is an urgent need for further clinical studies to evaluate response to chloramphenicol in such cases. Antimicrobial susceptibility data and MIC distribution favour use of ampicillin as a drug of choice for the treatment of enteric fever. Third generation cephalosporins are also useful but their use should be restricted for complicated cases. SN - 0255-0857 UR - https://www.unboundmedicine.com/medline/citation/16687859/Treatment_of_enteric_fever_in_children_on_the_basis_of_current_trends_of_antimicrobial_susceptibility_of_Salmonella_enterica_serovar_typhi_and_paratyphi_A_ L2 - http://www.ijmm.org/article.asp?issn=0255-0857;year=2006;volume=24;issue=2;spage=101;epage=106;aulast=Manchanda DB - PRIME DP - Unbound Medicine ER -