The anatomy of an epidemic (the final report on an epidemic of multidrug resistant enteric fever in eastern India).

Two hundred and forty two patients of enteric fever were treated at Command Hospital (EC) Calcutta, during the period 1989-90. The mean age of the patients was 28.4 (range 2-60) years and 119 (49.2%) of them were males. Fever (100%), headache (55%), diarrhoea (25.2%), intestinal bleeding (2.9%) and icterus (3.7%) were the main presenting features. Blood cultures were positive in 216 (%) patients. A majority of the isolates were found to be resistant to all four commonly used drugs for enteric fever i.e. chloramphenicol, ampicillin, cotrimoxazole and furazolidone. The commonest phage type found in the resistant strains was 51 (biotype-1). Two plasmids of 14 and 120 kd size were detected in the resistant strains but not in the sensitive strains. Clinical response to gentamicin was not satisfactory in spite of all strains showing in vitro sensitivity. Ciprofloxacin proved to be a safe and effective drug for the treatment of multidrug resistant enteric fever.