Ceftriaxone therapy in ciprofloxacin treatment failure typhoid fever in children

Background & objectives: The rapid spread of multidrug resistant (MDR) typh oid fever has posed a great challenge for the treatment of these cases the world over. After the emergence of chloramphenicol resistant Salmonella typ hi strains, ciprofloxacin has become the drug of choice for the treatment o f typhoid fever even in the paediatric age group. This study evaluated the role of ceftriaxone therapy in bacteriologically confirmed MDR typhoid case s who did not respond to 12-14 days of ciprofloxacin therapy. Attempts have also been made to investigate the in vitro susceptibility of isolated S. t yphi strains to chloramphenicol, ciprofloxacin and ceftriaxone. Methods: A total of 140 children, aged 3-10 yr, clinically diagnosed as hav ing typhoid fever, without any clinical response after 12-14 days of ciprof loxacin therapy were screened for S. typhi by blood culture. In the bacteri ologically positive children the treatment was changed to intravenous ceftr iaxone for 14 days. The isolated strains of S. typhi were tested for in vit ro antimicrobial susceptibility. Results: Clinical and bacteriological cure was observed with intravenous ce ftriaxone therapy in all the 32 bacteriologically positive patients. All is olated S typhi strains were uniformly (100%) susceptible to ciprofloxacin a nd ceftriaxone but 50 per cent of the strains were resistant to chloramphen icol. The MIC values of chloramphenicol, ciprofloxacin and ceftriaxone rang ed between 125-500, 0.062-5-0.5 and < 0.0625 mug/ml respectively. Interpretation & conclusion: The study indicates that although the S typhi strains were susceptible to ciprofloxacin in vitro, the patients did not re spond clinically and bacteriologically to ciprofloxacin therapy. Hence, cip rofloxacin may not represent a reliable and useful option for treating MDR typhoid fever, ceftriaxone may be an effective alternative for the treatmen t of such cases.