Are new antibiotics essential in the treatment of Salmonella typhi enteric fever? A comparison between enteric fever due to sensitive and resistant Salmonella in Ras Al-Kaimah, United Arab Emirates.

Abstract

Objectives: Document the magnitude of the problem of multiresistant Salmonella typhi in the Emirates and to try to predict clinically if enteric fever patients are harbouring S. typhi sensitive or are resistant to conventional antibiotics. Setting: The Medical Department of the Self Bin Ghubash Hospital. Ras Al-Khaimah, United Arab Emirates. Material and methods: A total of 51 culture proven enteric fever inpatients were studied to see the antibiotic susceptibility pattern. They were grouped into resistant or sensitive S. typhi according to the organism's susceptibility to conventional antibiotics, Twenty four clinical events were compared in both groups. Results: Organisms were statistically significantly resistant to chloramphenicol, co-trimoxozole and ampicillin (conventional antibiotics). All isolates were 100% sensitive to aminoglycosides, ceftazidime and aztreonam. Twenty six patients were grouped resistant and 25 sensitive. Statistically the duration of fever before presentation was 8.52 +/- 5.23 and 13.04 +/- 8.35 days which was significantly different in the sensitive and resistant, respectively (p < 0.03). The defervescence was shorter in patients treated with conventional antibiotics 5.72 +/- 2.48 days compared to 10.69 +/- 5.08 days in the resistant group(p < 0.0001). Conclusions: Multiresistant S. typhi is common in the area ranging between 40% to 60% of S. typhi isolates. A new policy of efficient non-costly parenteral and oral antibiotics should be adopted and the use of quinolones should be encouraged for the time being. The longer the duration of fever before presentation the more likely S. typhi isolates will be resistant to conventional antibiotics.