Current perspectives of enteric fever: a hospital-based study from India

Ann Trop Paediatr. 2005 Sep;25(3):161-74. doi: 10.1179/146532805X58085.


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.

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Anti-Infective Agents / therapeutic use
  • Child
  • Child, Preschool
  • Ciprofloxacin / therapeutic use
  • Drug Resistance, Multiple, Bacterial
  • Female
  • Hospitalization
  • Humans
  • India / epidemiology
  • Infant
  • Male
  • Microbial Sensitivity Tests
  • Nalidixic Acid / therapeutic use
  • Retrospective Studies
  • Risk Factors
  • Salmonella paratyphi A / drug effects
  • Salmonella typhi / drug effects
  • Seasons
  • Serotyping
  • Sex Distribution
  • Typhoid Fever / complications
  • Typhoid Fever / drug therapy
  • Typhoid Fever / epidemiology*


  • Anti-Infective Agents
  • Nalidixic Acid
  • Ciprofloxacin