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Akinyemi K, Iwalokun B, Foli F, Oshodi K, Coker A. Prevalence of multiple drug resistance and screening of enterotoxin (stn) gene in Salmonella enterica serovars from water sources in Lagos, Nigeria. Public Health 2011; 125:65-71. [DOI: 10.1016/j.puhe.2010.11.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 10/01/2010] [Accepted: 11/04/2010] [Indexed: 10/18/2022]
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Gupta LK, Randhawa VS. Cipro ßoxacin Breakpoints in Enteric Fever: Time to Revise our Susceptibility Criteria. Indian J Med Microbiol 2008. [DOI: 10.1016/s0255-0857(21)01835-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Raveendran R, Wattal C, Sharma A, Oberoi JK, Prasad KJ, Datta S. HIGH LEVEL CIPROFLOXACIN RESISTANCE IN SALMONELLA ENTERICA ISOLATED FROM BLOOD. Indian J Med Microbiol 2008. [DOI: 10.1016/s0255-0857(21)01992-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kownhar H, Shankar EM, Rajan R, Rao UA. Emergence of nalidixic acid-resistant Salmonella enterica serovar Typhi resistant to ciprofloxacin in India. J Med Microbiol 2007; 56:136-137. [PMID: 17172529 DOI: 10.1099/jmm.0.46763-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hayath Kownhar
- Department of Microbiology, Faculty of Medicine, Dr ALM PG Institute of Basic Medical Sciences, University of Madras, Taramani Campus, Chennai 600 113, India
| | - Esaki Muthu Shankar
- Department of Microbiology, Faculty of Medicine, Dr ALM PG Institute of Basic Medical Sciences, University of Madras, Taramani Campus, Chennai 600 113, India
| | - Ramachandran Rajan
- Department of Microbiology, Faculty of Medicine, Dr ALM PG Institute of Basic Medical Sciences, University of Madras, Taramani Campus, Chennai 600 113, India
| | - Usha Anand Rao
- Department of Microbiology, Faculty of Medicine, Dr ALM PG Institute of Basic Medical Sciences, University of Madras, Taramani Campus, Chennai 600 113, India
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Parry CM, Ho VA, Phuong LT, Bay PVB, Lanh MN, Tung LT, Tham NTH, Wain J, Hien TT, Farrar JJ. Randomized controlled comparison of ofloxacin, azithromycin, and an ofloxacin-azithromycin combination for treatment of multidrug-resistant and nalidixic acid-resistant typhoid fever. Antimicrob Agents Chemother 2006; 51:819-25. [PMID: 17145784 PMCID: PMC1803150 DOI: 10.1128/aac.00447-06] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Isolates of Salmonella enterica serovar Typhi that are multidrug resistant (MDR, resistant to chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) and have reduced susceptibility to fluoroquinolones (nalidixic acid resistant, Na(r)) are common in Asia. The optimum treatment for infections caused by such isolates is not established. This study compared different antimicrobial regimens for the treatment of MDR/Na(r) typhoid fever. Vietnamese children and adults with uncomplicated typhoid fever were entered into an open randomized controlled trial. Ofloxacin (20 mg/kg of body weight/day for 7 days), azithromycin (10 mg/kg/day for 7 days), and ofloxacin (15 mg/kg/day for 7 days) combined with azithromycin (10 mg/kg/day for the first 3 days) were compared. Of the 241 enrolled patients, 187 were eligible for analysis (186 S. enterica serovar Typhi, 1 Salmonella enterica serovar Paratyphi A). Eighty-seven percent (163/187) of the patients were children; of the S. enterica serovar Typhi isolates, 88% (165/187) were MDR and 93% (173/187) were Na(r). The clinical cure rate was 64% (40/63) with ofloxacin, 76% (47/62) with ofloxacin-azithromycin, and 82% (51/62) with azithromycin (P = 0.053). The mean (95% confidence interval [CI]) fever clearance time for patients treated with azithromycin (5.8 days [5.1 to 6.5 days]) was shorter than that for patients treated with ofloxacin-azithromycin (7.1 days [6.2 to 8.1 days]) and ofloxacin (8.2 days [7.2 to 9.2 days]) (P < 0.001). Positive fecal carriage immediately posttreatment was detected in 19.4% (12/62) of patients treated with ofloxacin, 6.5% (4/62) of those treated with the combination, and 1.6% (1/62) of those treated with azithromycin (P = 0.006). Both antibiotics were well tolerated. Uncomplicated typhoid fever due to isolates of MDR S. enterica serovar Typhi with reduced susceptibility to fluoroquinolones (Na(r)) can be successfully treated with a 7-day course of azithromycin.
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Walia M, Gaind R, Mehta R, Paul P, Aggarwal P, Kalaivani M. Current perspectives of enteric fever: a hospital-based study from India. ACTA ACUST UNITED AC 2005; 25:161-74. [PMID: 16156980 DOI: 10.1179/146532805x58085] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
UNLABELLED The last two decades have seen a change in the pattern of enteric fever with the emergence of multidrug-resistant strains (MDRS), particularly strains resistant to nalidixic acid. AIM The aim of the study was to undertake a retrospective analysis of blood culture-confirmed cases of enteric fever diagnosed at Safdarjang Hospital, New Delhi, India from January 2001 to December 2003. METHODS The epidemiological details, clinical features, treatment outcome and antimicrobial resistance patterns were studied. RESULTS Of 377 blood culture-positive cases, 80.6% were Salmonella typhi and 19.4% Salmonella paratyphi A; 21.7% were children aged under 5 years and 6.1% were under 2 years. A significant decline in MDRS was observed, from 21.9% in 2001 to 12.4% in 2003 (p=0.04). There was a significant increase in nalidixic acid-resistant Salmonella (NARS) from 56.9% in 2001 to 88.9% in 2003 (p=0.0001). Complete resistance to ciprofloxacin (MIC>4 microg/ml) was detected in only two isolates, both Salmonella paratyphi A. Minimal inhibitory concentrations (MICs) of ciprofloxacin for NARS were increased (0.125-0.5 microg/ml) but were within National Committee for Clinical Laboratory Standards susceptibility ranges. NARS had a significantly longer fever defervescence time (7.7 vs 4.7 days, p<0.001) and hospital stay (12.1 vs 8.2 days, p<0.001), and higher rates of complications (55.5% vs 24.0%, p=0.014) and mortality than nalidixic acid-sensitive Salmonella (NASS). The rate of isolation of MDRS was higher in NARS than NASS (18.8% vs 7.3%, p=0.013). CONCLUSION The high rate of occurrence of enteric fever in children <5 years and also of infections caused by Salmonella paratyphi A in India calls for critical re-assessment of vaccination strategy. Nalidixic acid resistance and rising MICs of fluoroquinolones in Salmonella spp pose a new global threat requiring debate on the optimum treatment of enteric fever.
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Affiliation(s)
- Mandeep Walia
- Department of Pediatrics, V. M. Medical College and Safdarjang Hospital, New Delhi, India
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Abstract
Typhoid fever is estimated to have caused 21.6 million illnesses and 216,500 deaths globally in 2000, affecting all ages. There is also one case of paratyphoid fever for every four of typhoid. The global emergence of multidrug-resistant strains and of strains with reduced susceptibility to fluoroquinolones is of great concern. We discuss the occurrence of poor clinical response to fluoroquinolones despite disc sensitivity. Developments are being made in our understanding of the molecular pathogenesis, and genomic and proteomic studies reveal the possibility of new targets for diagnosis and treatment. Further, we review guidelines for use of diagnostic tests and for selection of antimicrobials in varying clinical situations. The importance of safe water, sanitation, and immunisation in the presence of increasing antibiotic resistance is paramount. Routine immunisation of school-age children with Vi or Ty21a vaccine is recommended for countries endemic for typhoid. Vi vaccine should be used for 2-5 year-old children in highly endemic settings.
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Affiliation(s)
- M K Bhan
- All India Institute of Medical Sciences, New Delhi 110029, India.
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Nkemngu NJ, Asonganyi EDN, Njunda AL. Treatment failure in a typhoid patient infected with nalidixic acid resistant S. enterica serovar Typhi with reduced susceptibility to ciprofloxacin: a case report from Cameroon. BMC Infect Dis 2005; 5:49. [PMID: 15969764 PMCID: PMC1184073 DOI: 10.1186/1471-2334-5-49] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 06/21/2005] [Indexed: 11/26/2022] Open
Abstract
Background Fluoroquinolones or third generation cephalosporins are the drugs of choice for the treatment of typhoid fever. Treatment failure with fluoroquinolones has been reported in Asia and Europe. We report a case of ciprofloxacin treatment failure in typhoid fever in Cameroon. Case presentation A 29-year-old female patient with suspected typhoid fever from Kumba, Cameroon, yielded growth of Salmonella enterica serovar Typhi in blood culture. The isolate was resistant to nalidixic acid but sensitive to ciprofloxacin by disc diffusion test. However, the patient did not respond to treatment with ciprofloxacin, although the isolate was apparently susceptible to ciprofloxacin. Conclusion Treatment failure with ciprofloxacin in our case indicates the presence of nalidixic acid resistant S. enterica serovar Typhi (NARST) with reduced susceptibility to ciprofloxacin in Cameroon (Central Africa).
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Affiliation(s)
- Njinkeng J Nkemngu
- St. John's Maternity and Hospital, Fiango, Kumba, Cameroon
- St. Joseph's medical Centre, Yoke-Muyuka, Cameroon
| | - Etienne DN Asonganyi
- St. Joseph's medical Centre, Yoke-Muyuka, Cameroon
- University Teaching Hospital, University of Yaounde I, Yaounde, Cameroon
| | - Anna L Njunda
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
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Murray A, Coia JE, Mather H, Brown DJ. Ciprofloxacin resistance in non-typhoidal Salmonella serotypes in Scotland, 1993–2003. J Antimicrob Chemother 2005; 56:110-4. [PMID: 15914492 DOI: 10.1093/jac/dki164] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine the levels of resistance to ciprofloxacin among non-typhoidal salmonellae in Scotland. METHODS Etest strips were used to determine the ciprofloxacin MICs for nalidixic acid-resistant salmonellae isolated from humans during 1993-2003. RESULTS The percentage of nalidixic acid-resistant salmonellae isolated from human infection in Scotland has increased from 1.4% in 1993, to 8.8% in 1998 and 21.3% in 2003. Of 493 strains of nalidixic acid-resistant Salmonella tested, a single isolate of Salmonella Typhimurium RDNC was resistant to ciprofloxacin at the NCCLS breakpoint of 4 mg/L. Eleven isolates were resistant at the Scottish Salmonella Reference Laboratory breakpoint of 0.5 mg/L, while 466 isolates (94.5%) had reduced susceptibility with MICs of > or =0.125 mg/L and <0.5 mg/L. CONCLUSIONS These results show that very few non-typhoidal isolates of Salmonella in Scotland that are resistant to nalidixic acid are also resistant to ciprofloxacin at the NCCLS recommended breakpoint of 4 mg/L. The majority of isolates examined, however, do show reduced susceptibility at 0.125 mg/L. This confirms the necessity for continuing antimicrobial surveillance of resistance to this important antibiotic.
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Affiliation(s)
- A Murray
- Scottish Salmonella Reference Laboratory, Stobhill Hospital, Glasgow, UK
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Parry CM. The treatment of multidrug-resistant and nalidixic acid-resistant typhoid fever in Viet Nam. Trans R Soc Trop Med Hyg 2004; 98:413-22. [PMID: 15138078 DOI: 10.1016/j.trstmh.2003.10.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2003] [Accepted: 10/01/2003] [Indexed: 11/18/2022] Open
Abstract
Multidrug-resistant (MDR) Salmonella Typhi (resistant to chloramphenicol, ampicillin, and trimethoprim-sulphamethoxazole) and isolates with reduced susceptibility to fluoroquinolones (indicated by resistance to nalidixic acid, NaR) have caused epidemics and become endemic in southern Viet Nam during the 1990s. Short courses of ofloxacin have proved acceptable for treating MDR/NaS isolates of S. Typhi (ofloxacin MIC90 = 0.06 mg/l) causing uncomplicated disease. Ofloxacin (10-15 mg/kg/d) given for 2, 3, or 5 d cured >90% of patients with an average fever clearance time (FCT) of 4 d. Less than 3% of patients relapsed or had a positive post-treatment stool culture. In contrast, the response of NaR isolates (ofloxacin MIC90 = 0.5 mg/l) to such regimens is poor. For example, ofloxacin (20 mg/kg/d) given for 7 d cured only 75% of patients, with an FCT of 7 d, and 19% of patients had positive post-treatment faecal cultures. Currently available alternatives for NaR infections include ceftriaxone, cefixime, and azithromycin. These antimicrobials are reasonably effective but expensive. New, effective, and affordable regimens are needed to treat these NaR infections. Short courses of the new generation fluoroquinolones or combinations of the available antimicrobials are possible options.
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Affiliation(s)
- Christopher M Parry
- Oxford University Wellcome Trust Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam.
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Gendrel D, Chalumeau M, Moulin F, Raymond J. Fluoroquinolones in paediatrics: a risk for the patient or for the community? THE LANCET. INFECTIOUS DISEASES 2003; 3:537-46. [PMID: 12954559 DOI: 10.1016/s1473-3099(03)00736-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Fluoroquinolones are an important group of antibiotics widely used in adult patients because of their excellent tissue penetration and their bactericidal activity. They are not authorised for paediatric use (except the limited indication of pseudomonas infections in cystic fibrosis), however, because of the potential for joint toxicity reported from experiments with young animals. Despite the absence of official approval, fluoroquinolones are widely used in paediatrics as second-line antibiotics when all other treatments have failed. Most of the information available about paediatric use concerns ciprofloxacin, which is used in children much more often than the other members of this class. The published paediatric series have shown that frequency of articular side-effects varies according to age: all the surveys have reported frequencies of around 0.1% in adults and 2-3% in children. Outside of cystic fibrosis and severe infections in which no other treatment is possible, the only paediatric situations where fluoroquinolones are superior to standard treatments for children, in speed of recovery and comfort as well as in efficacy, are typhoid fever, severe shigella dysenteries, and enterobacteria meningitis. Should the use of new fluoroquinolones active against pneumococci be authorised for upper respiratory infections (including recurrent otitis) in children, the potential emergence and dissemination of pneumococci strains in which multidrug resistance includes fluoroquinolones would create a real risk in the community. It is, therefore, important to continue the policy of second-line use in children, only after failure of an earlier treatment, and when other antibiotics approved for paediatric use cannot be used.
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Affiliation(s)
- Dominique Gendrel
- Department of Paediatrics, Hôpital Saint Vincent de Paul-Cochin, Paris, France.
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Affiliation(s)
- Christopher M Parry
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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