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Resistance Patterns of Typhoid Fever in Children: A Longitudinal Community-Based Study.
[typhoid]
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
.
Diseases
Validation
Diseases presenting
"large scale"
symptom
achondroplasia
erythropoietic protoporphyria
fabry disease
locked-in syndrome
typhoid
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