Emergence of Multidrug-Resistant (MDR) and Extensively Drug- Resistant (XDR) Typhoid Fever in Aligarh, Uttar Pradesh: A Case Series

Abstract

Salmonella Typhi is a Gram-negative rod which causes enteric fever in humans. The introduction of antibiotics to treat typhoid has considerably improved its outcome, but rising multidrug-resistant (MDR) and extensively drug-resistant (XDR) cases due to injudicious use of antibiotics is a matter of grave concern. This case series presents four cases of XDR typhoid fever from a tertiary care centre in northern India. The patients presented in Pediatrics OPD between June 2022 to August 2022, and were admitted and managed in the Pediatrics ward, Jawaharlal Nehru Medical College, AMU, Aligarh. There were two males and two females with a mean age of 10.5 ± 1.73 years. All the patients presented with fever of more than 10 days duration (median duration of symptom before admission 13 ± 5.74 days, IQR 10.5-20.5) and had been on oral cefixime for enteric fever. But, these patients did not show clinical resolution of fever and other symptoms such as fatigue, weakness etc. After the addition of Azithromycin, patients showed clinical improvement and were subsequently discharged over a period of 6-7 days. We are witnessing rapid emergence of XDR typhi strains across the world particularly in resource limited countries like ours. Azithromycin can be used as safer alternative in both MDR and XDR salmonella bacteremia. Additionally, blood culture should be sent of all suspected patients before start of antibiotics.