Multi-drug Resistant Enteric Fever in children

Abstract

Objective: To see the sensitivity pattern of Salmonella and response of the patients to antimicrobial therapy.

Design: A prospective random study.

Place and duration of study: Study was carried out in pediatric A unit at PGMI/Lady Reading Hospital, Peshawar from March, 1993 to February, 1994.

Materials and methods: All clinically suspected cases of enteric fever were investigated but inclusion criterion was positive blood and/or bone marrow cultures. After history, examination and investigations, patients were randomly started on amoxycillin or chloramphenicol (first line antibiotics). Those who did not respond to either within 7 days, were switched over to either ofloxacin (in children above 5 years of age) or one of the third generation cephalosporins (second line antimicrobials) according to culture results. The antimicirobial to which the patient responded was continued for 2 weeks. Patient were followed up for one month for detection of adverse drug reaction (if any).

Results: Eighty six patients were investigated but only 50 had positive culture and these were included in study analysis. The organism isolated were S.typhi in 49 cases (98%) and S. paratyphi A in one case (2%). The single S.paratphy A isolate was sensitive to all the antimicrobials tested. Out of 49 isolates of S. typhi, only 5 (10.2 %) were snsitive to all antityphoid chemoterapeutic agents, while 44 (89.8%) showed resistance against multiple drugs. Clinically, 22(44%) patients showed satisfactory response to primary antibiotics, while remaining 28 (56 %) patients had to be switched over to either quinolones (above 5 years of age) or third generation cephalosporins. Response to these agents was good with defervescence within 7 days.

Conclusion: Third generation cephalosporins appear as treatment of choice for multidrug resistant typhoid fever in children, although their cost and parenteral administration are drawbacks. Quinolones are the most effective drugs against typhoid fever but there is risk of epiphyseal damage in children. In this study this side effect was not noted, although sample size was a small one. Their use can still be recommended in multidrug resistant enteric fever in children above 5 years.