Infect Chemother.  2007 Feb;39(1):46-49.

An Imported Case of Typhoid Fever Refractory to Ciprofloxacin Treatment

• Park JE
• Chung MH
• Lee JS
• Kim JJ

Abstract

Salmonella enterica serovar Typhi infection is widely prevalent in developing countries; its treatment has been complicated by the emergence of resistance to antimicrobial agents. Fluoroquinolones are orally administered antimicrobials effective against typhoid fever, including that caused by the multidrug-resistant S. Typhi. They are relatively inexpensive and more convenient to administer com pared to third-generation cephalosporins; hence, they constitute the drugs of choice for the treatment of typhoid fever in developing countries. In Asian countries, however, resistance to nalidixic acid-a prototype of quinolone antibiotics-diminishes the value of fluoroquinolones with regard to the treatment of typhoid fever. We experienced a case of nalidixic acid-resistant S. Typhi infection imported from Pakistan that was clinically refractory to ciprofloxacin treatment. A 31-year-old male presented with a fever of 14 days' duration after returning from his native Pakistan. Oral ciprofloxacin was empirically administered for three days without any beneficial effect. His illness, however, improved after the administration of ceftriaxone for three days. Blood culture revealed the presence of S. Typhi that was resistant to nalidixic acid (minimal inhibitory concentration > or =32 microgram/mL) but susceptible to ciprofloxacin (minimal inhibitory concentration=1.0 microgram/mL) in vitro.

Keyword

Salmonella enterica serovar Typhi; Resistance; Ciprofloxacin; Nalidixic acid

MeSH Terms

Adult
Anti-Infective Agents
Asian Continental Ancestry Group
Ceftriaxone
Cephalosporins
Ciprofloxacin*
Developing Countries
Fever
Fluoroquinolones
Humans
Male
Nalidixic Acid
Pakistan
Salmonella typhi
Typhoid Fever*
Anti-Infective Agents
Ceftriaxone
Cephalosporins
Ciprofloxacin
Fluoroquinolones
Nalidixic Acid