[A case of Salmonella enterica serovar typhi with decreased susceptibility to ciprofloxacin]

Med Mal Infect. 2010 Dec;40(12):691-5. doi: 10.1016/j.medmal.2010.06.009. Epub 2010 Aug 17.
[Article in French]

Abstract

The use of fluoroquinolone (FQ) as first line therapy for typhoid fever should be reconsidered because of the emergence of Salmonella Typhi and Paratyphi A strains with decreased susceptibility to FQ, mainly from Asia. Relapse can occur when ciprofloxacin MIC is over 0.12 mg/l, as illustrated by our case report. Azithromycin can be used successfully for patients infected with reduced ciprofloxacin susceptibility isolates. Literature review led us to suggest a new therapeutic strategy for uncomplicated typhoid fever, the antibiotic was chosen according to nalidixic acid susceptibility and ciprofloxacin MIC of the strain. High-dose intravenous ceftriaxone (4 g per day) is always efficient in first line therapy. Depending on FQ susceptibility testing results, it is relayed by oral therapy with a FQ (ciprofloxacin 500 mg bid for 7 days) if the isolate has maintained susceptibility, or azithromycin (1 g first day and 500 mg per day, 7 days) if the isolate is resistant to nalidixic acid or has a ciprofloxacin MIC superior to 0.12 mg/l.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / drug therapy
  • Bacteremia / microbiology
  • Ceftriaxone / therapeutic use
  • Ciprofloxacin / pharmacology*
  • Ciprofloxacin / therapeutic use
  • Drug Resistance, Multiple, Bacterial
  • Drug Therapy, Combination
  • Humans
  • India
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Nalidixic Acid / pharmacology
  • Ofloxacin / therapeutic use
  • Randomized Controlled Trials as Topic / statistics & numerical data
  • Recurrence
  • Salmonella paratyphi A / drug effects
  • Salmonella typhi / drug effects*
  • Salmonella typhi / isolation & purification
  • Travel
  • Typhoid Fever / drug therapy
  • Typhoid Fever / microbiology*

Substances

  • Anti-Bacterial Agents
  • Nalidixic Acid
  • Ciprofloxacin
  • Ceftriaxone
  • Ofloxacin