Typhoid and paratyphoid fever
2005; Elsevier BV; Volume: 366; Issue: 9497 Linguagem: Inglês
10.1016/s0140-6736(05)67653-2
ISSN1474-547X
Autores Tópico(s)Hepatitis Viruses Studies and Epidemiology
ResumoIn the Seminar by M K Bhan and colleagues,1Bhan MK Bahl R Bhatnagar S Typhoid and paratyphoid fever.Lancet. 2005; 366: 749-762Summary Full Text Full Text PDF PubMed Scopus (387) Google Scholar the figure showing the global distribution of antimicrobial resistance in Salmonella enterica serotype typhi (S typhi) does not mention Nepal as having nalidixic acid resistance. However, a prospective study in our institution2Murdoch DR Woods CW Zimmerman MD et al.The etiology of febrile illness in adults presenting to Patan Hospital in Kathmandu, Nepal.Am J Trop Med Hyg. 2004; 70: 670-675PubMed Google Scholar showed that more than 50% of S typhi isolates are nalidixic acid resistant, and there are concerns about clinical failure of ciprofloxacin.3Ansari I Adhikari N Pandey R Dangal MM Karanjit R Achary A Enteric fever: is ciprofloxacin failing?.J Nepal Paed Soc. 2002; 20: 6-16Google Scholar High-dose ofloxacin (20 mg/kg per day) is our current standard treatment. Another epidemiological study4Lewis MD Serichantalergs O Pitarangsi C et al.Typhoid fever: a massive, single point-source, multidrug-resistant outbreak in Nepal.Clin Infect Dis. 2005; 40: 554-561Crossref PubMed Scopus (64) Google Scholar in Bharatpur, Nepal, also reports nalidixic-acid-resistant S typhi. Without newer treatment options, the emergence of this resistance poses a real threat and signals a return to the pre-antibiotic era in Nepal. On a separate issue, if blood cultures remain negative after 72 h in our institution, we continue incubating them for 7 days. We have increasing experience of growing S typhi and S paratyphi even on the 6th, 7th, and 8th days of incubation. We declare that we have no conflict of interest.
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