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Antimicrob Agents Chemother. 1977 April; 11(4): 645-650
Copyright © 1977 American Society for Microbiology. All Rights Reserved.

Therapy of Antimicrobial-Resistant Typhoid Fever

^* Division of Geographic Medicine, Department of Medicine, Case Western Reserve University and University Hospitals, Cleveland, Ohio 44106
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland 21205
Cho-Quan Hospital, Saigon, South Vietnam
Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73190

ABSTRACT

Antimicrobial-resistant typhoid fever in Saigon was studied by examining in vitro antimicrobial susceptibilities of Salmonella typhi strains and conducting a randomized clinical trial of ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ). Isolates of S. typhi were obtained from blood or stool cultures of 90 patients. Of 87 isolates tested for antimicrobial susceptibility, 65 (75%) were resistant (R) to chloramphenicol, streptomycin, sulfonamide, and tetracycline, and 22 (25%) were susceptible (S). The drug resistance was transferable to Escherichia coli and was found in 11 different Vi-phage types. All isolates were susceptible to ampicillin and to TMP-SMZ. Agar dilution studies of TMP and SMZ showed synergistic inhibition of growth in all 18 S isolates and in 12 of 48 R isolates tested. The clinical trial of ampicillin and TMP-SMZ showed that both drugs were equally effective. Treatment failure with both drugs was more frequent in patients with S isolates than in patients with R isolates. Therefore, in an area where antimicrobial-resistant typhoid fever exists, patients with R isolates should receive either ampicillin or TMP-SMZ, but patients with S isolates should be treated with chloramphenicol.

¹ Deceased April 1975. We dedicate this work to his bereaved family and his exemplary devotion to the treatment and prevention of infectious diseases in Vietnam.