Department of Microbiology and Immunology, Ross University School of Medicine, North Brunswick, NJ 08902, USA.
Clin Microbiol Infect. 2011 Jul;17(7):959-63. doi: 10.1111/j.1469-0691.2011.03552.x.
Emergence of multidrug resistance and decreased ciprofloxacin susceptibility (DCS) in Salmonella enterica serovar Typhi in South Asia have rendered older drugs, including ampicillin, chloramphenicol, trimethoprim-sulphamethoxazole, ciprofloxacin, and ofloxacin, ineffective or suboptimal for typhoid fever. Ideally, treatment should be safe and available for adults and children in shortened courses of 5 days, cause defervescence within 1 week, render blood and stool cultures sterile, and prevent relapse. In this review of 20 prospective clinical trials that enrolled more than 1600 culture-proven patients, azithromycin meets these criteria better than other drugs. Among fluoroquinolones, which are more effective than cephalosporins, gatifloxacin appears to be more effective than ciprofloxacin and ofloxacin for patients infected with bacteria showing DCS. Ceftriaxone continues to be useful as a back-up choice, and chloramphenicol, despite its toxicity for bone marrow and history of plasmid-mediated resistance, is making a comeback in developing countries that show their bacteria to be susceptible to it.
在南亚，伤寒沙门氏菌血清型 Typhi 出现了多重耐药性和环丙沙星敏感性降低（DCS），使得包括氨苄西林、氯霉素、甲氧苄啶-磺胺甲恶唑、环丙沙星和氧氟沙星在内的旧药物对伤寒无效或效果不佳。理想情况下，治疗应该安全且适用于成人和儿童，疗程缩短至 5 天，在 1 周内退热，使血液和粪便培养无菌，并防止复发。在这项对 20 项前瞻性临床试验的综述中，这些试验共纳入了 1600 多名培养阳性的患者，阿奇霉素比其他药物更符合这些标准。在氟喹诺酮类药物中，与头孢菌素类药物相比，加替沙星对显示 DCS 的细菌感染患者似乎比环丙沙星和氧氟沙星更有效。头孢曲松仍然是一种有用的后备选择，而氯霉素尽管对骨髓有毒性，并且存在质粒介导的耐药性，但在显示对其敏感的发展中国家又重新流行起来。
