Sajjad H Mirza.
Multi-drug resistant Typhoid – A global review.
Infect Dis J Jan ;14(1):17-20.

Typhoid fever caused by Salmonella enterica Serovor typhi (S.Typhi), remains a significant problem in developing countries. It is estimated that there are more than 16 million cases of typhoid each year, resulting in at least 600,000 deaths1, with annual attack rates ranging from 358 to 1100 per 100,000 population2,3. In the pre-antibiotic era mortality rates of over 20% were not uncommon. The introduction of first chloramphenicol and subsequently ampicillin and co-trimoxazole greatly improved the outlook, decreasing mortality rates to as low as 1%. This progress has been seriously compromised by emergence of multi-drug resistant (MDR) typhoid, carrying resistance genes on the plasmid4, which has returned the progress of the disease to that found in the pre- antibiotic era. The main therapeutic option is to use fluoroquinolones, which have proved highly effective and safe, even in short course regimens. However, in certain areas e.g., Vietnam, their value has been eroded by emergence of chromosomal mutations in DNA gyrase and topoisomerase gene. We have also seen low level resistance to fluoroquinolone manifested by nalidixic acid disc resistance which has lead to therapeutic failure in these patients. Alternative agents include azithromycin or cefixime, but neither are ideal.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com