Kaurthe Jaspal
Assistant Professor, Department of Microbiology Institution Punjab Institute of Medical Sciences , Jalandhar, India .
J Clin Diagn Res. 2013 Mar;7(3):576-9. doi: 10.7860/JCDR/2013/4765.2831. Epub 2013 Mar 1.
Multidrug-resistant typhoid fever (MDRTF) is a major public health problem in developing countries and is an emerging problem in the developed world. Because of the difficulties in preventing typhoid by public health measures or immunization in developing countries, great reliance is placed on antimicrobial chemotherapy. The treatment should commence as soon as the clinical diagnosis is made rather than after the results of antimicrobial susceptibility tests but the existence of MDRTF poses a serious clinical dilemma in the selection of empiric antimicrobial therapy. With the widespread emergence and spread of strains resistant to chloramphenicol, ampicillin and trimethoprim, ciprofloxacin became the drug of choice for the treatment of typhoid fever. However, of late the efficacy of fluoroquinolones too has been questioned, mainly due to increasing reports of increasing defervescence time and poor patient response. This indicates that the organism has begun to develop resistance to fluoroquinolones, and is corroborated by a steady increase in Minimum Inhibitory Concentration (MIC) of ciprofloxacin. The therapeutics of ciprofloxacin-resistant enteric fever narrows down to third- and fourth-generation cephalosporins and azithromycin. However, the emergence of extended-spectrum b-lactamases (ESBLs) in typhoidal Salmonellae poses a new challenge and would greatly limit the therapeutic options leaving only tigecycline and carbepenems as secondary antimicrobial drugs. This increasing resistance is alarming and emphasizes the need of effective preventive measures to control typhoid and to limit the unnecessary use of antibiotics.
多重耐药性伤寒热（MDRTF）在发展中国家是一个重大的公共卫生问题，在发达国家也正成为一个新出现的问题。由于在发展中国家通过公共卫生措施或免疫接种预防伤寒存在困难，因此对抗菌化疗的依赖很大。治疗应在做出临床诊断后立即开始，而不是在抗菌药敏试验结果出来之后，但MDRTF的存在给经验性抗菌治疗的选择带来了严重的临床困境。随着对氯霉素、氨苄西林和甲氧苄啶耐药菌株的广泛出现和传播，环丙沙星成为治疗伤寒热的首选药物。然而，近来氟喹诺酮类药物的疗效也受到质疑，主要是因为越来越多的报告称热退时间延长且患者反应不佳。这表明该病原体已开始对氟喹诺酮类药物产生耐药性，环丙沙星最低抑菌浓度（MIC）的稳步上升也证实了这一点。对环丙沙星耐药的肠热病的治疗方法缩小到第三代和第四代头孢菌素以及阿奇霉素。然而，伤寒沙门氏菌中广谱β-内酰胺酶（ESBLs）的出现带来了新的挑战，将极大地限制治疗选择，仅留下替加环素和碳青霉烯类作为二线抗菌药物。这种耐药性的不断增加令人担忧，并强调需要采取有效的预防措施来控制伤寒并限制抗生素的不必要使用。
