Impact of Typhoid Fever and its Treatment in a Tertiary Level Hospital in Dhaka

Abstract

Typhoid and paratyphoid fevers are caused by the bacteria Salmonella typhi and Salmonella paratyphi respectively. Typhoid fever is a major public health problem and one of the leading causes of febrile illness of children in developing countries. An estimated 600,000 deaths occur from typhoid fever annually throughout the world. Doctors are likely to suspect typhoid fever based on symptoms and medical history. But the diagnosis is usually confirmed by identifying S. typhi in a culture of the patient's blood or other body fluid or tissue and is placed on a special medium that encourages the growth of bacteria. Typhoid fever is endemic in Bangladesh. Until the mid-1980s, Chloramphenicol, Ampicillin or Cotrimoxazole, were the standard treatments. Multi-drug resistance defined as resistance to these first-line agents used to treat typhoid has been endemic in most of South East Asia and the Indian Subcontinent for many years. However, in children, it poses a major therapeutic dilemma where the disorder is fast assuming epidemic proportions. Since then, Ciprofloxacine or third generation cephalosporins, Ceftriaxone have become the first-line treatment for typhoid fever. Infection with nalidixic acid-resistant S. typhi with decreased susceptibility to Ciprofloxacin has been reported from Vietnam, Tajikistan, the UK, India and Bangladesh since 1997. In the UK, the percentage of S. enterica serover Typhi strains showing decreased seuceptibility to Ciprofloxacin increased from 2.7% in 1995 to 21 % in 1998. Hence, the routine disk diffusion test with Ciprofloxacin disk alone is unable to detect such cases. (Asna, S.M.Z.H., et.al). Currently, the recommendation for first-line therapy is Ceftriaxone but Ceftriaxone-resistant Salmonella typhi was detected in Bangladesh in 1999. In this hospital-based study, the patients were treated with the following drugs: Amoxycillin, Cefixime, Ceftriaxone, Ciprofloxacin, Gentamicin, Levofloxacin and Ofloxacin; among which Ceftriaxone was found to be mostly used and effective despite its cost and problems in administration. The determination and evaluation of the impact of sensitivity of various antibiotics on clinical response in patients with typhoid fever was the main concern of the present study.