Typhoid fever: narrowing therapeutic options in India.

Typhoid fever remains an important public health problem in India. One thousand four hundred fifty-eight blood cultures were screened, 178 grew out Salmonella enterica serovar Typhi. On agar dilution minimum inhibitory concentration (MIC) testing, 0.6% of the isolates were resistant to ciprofloxacin, 2% to cefotaxime and 1% to cefepime. Nalidixic acid resistance was observed in 51% isolates, of which 98.9% had decreased susceptibility (MIC > or = 0.125-4 microg/ml) to ciprofloxacin. One strain of nalidixic acid sensitive S. Typhi (NASST) also had a decreased MIC (0.125 microg/ml) to ciprofloxacin. Resistance to third and fourth generation cephalosporins is emerging in India and will gain significance in the coming decade. The molecular basis of resistance to cephalosporinsand ciprofloxacin resistance in NASST strains need to be further evaluated for S. Typhi.