“Ceftriaxone-Resistant Typhoid Cases in City Alarm Doctors”
Pune: At least two cases of antibiotic resistance in typhoid-causing bacteria have been reported by the city’s doctors, and some cases of Salmonella typhi have been shown to be unresponsive to ceftriaxone, a widely prescribed treatment for the infection in India, which experts have linked to the drug’s widespread and irrational use.
“Culture reports from at least two patients this year have verified ceftriaxone resistance. Fortunately, we were able to treat these patients effectively with azithromycin because the bacteria is still susceptible to it, Dr. Ameet Dravid, a senior expert in infectious diseases, told TOI.
The trend was concerning, according to the physicians, even if there are few cases of resistance right now. “Once resistance emerges, it can spread rapidly. It might be two cases today, but it could be ten or twenty tomorrow. Bacteria can accomplish this because they can transmit resistance genes between themselves. I hadn’t encountered any typhoid that was resistant to ceftriaxone until last year.
However, Dr. Dravid stated that this year we have begun to observe a few culture-proven cases, which is a positive but concerning indicator.
“We are now beginning to see occasional cases of Salmonella typhi not responding well to ceftriaxone, which is usually our first-line of treatment,” said Dr. Sujata Rege, a consultant in infectious diseases at Jupiter hospitals and Symbiosis University.
These samples are being sent to CMC Vellore for molecular testing. Gujarat had a typhoid outbreak that was resistant to ceftriaxone, and although the number of cases here is still small, resistance is growing.
She said that in such situations, doctors frequently need to switch to azithromycin, but it’s crucial to protect this medication by not using it indiscriminately for common respiratory illnesses. “Interestingly, older medications like chloramphenicol (which was long discontinued) and co-trimoxazole (Septran) are exhibiting renewed sensitivity against typhoid. The fact that this represents a change in resistance trends that were previously concentrated in Pakistan and Afghanistan but are now also manifesting in India is cause for concern. Resistance is missed unless blood cultures are performed from the start. We are less able to monitor and react to resistance trends when many patients are initiated on antibiotics like cefixime or ceftriaxone without cultures. According to Dr. Rege,
“Blood culture continues to be the gold standard for diagnosis and should ideally be conducted before any antibiotic is prescribed.”
“In the past, medications such ciprofloxacin and levofloxacin were effective against typhoid,” Dr Mahesh Kumar Manohar Lakhe, an infectious diseases specialist at Sahyadri Hospitals, informed TOI.
However, resistance to these agents has significantly risen during the past 20 to 30 years. Then, we began to depend more on third-generation cephalosporins, such as ceftriaxone. But lately, we are also starting to see a few instances of ceftriaxone resistance. In a patient who had traveled from Vasai, which is close to Mumbai, I have personally treated a case of ceftriaxone resistance that has been demonstrated by culture.
“Even though the numbers are very small, it indicates the beginning of a trend that has already been reported more widely in countries like Pakistan and Bangladesh,” Dr Lakhe stated. Although a lot of this is still unpublished data right now, coworkers in Delhi, Kolkata, Chennai, and other places have also said they’ve seen similar instances.
“Antibiotic resistance in typhoid is due not only to misuse of drugs in humans but also to rampant use of antibiotics in poultry and livestock,” stated Dr. Renu Bharadwaj, a former professor and microbiologist at BJ Medical College and Sassoon Hospital. Because birds are regularly administered antibiotics via their food, the Salmonella bacteria circulating in animals already contains resistance genes. Even if the patient has never taken these antibiotics before, such strains are immediately resistant when they infect people.
She went on to say that “another major issue is irrational prescribing practices in hospitals.” Without conducting a blood culture or antibiotic sensitivity test, many doctors prescribe patients greater antibiotics like ceftriaxone. Excessive use in hospitals and ICUs promotes the circulation and transmission of resistance genes to Salmonella. Consequently, if a patient genuinely requires ceftriaxone, the infection might not respond. We risk losing our last-line medications if stricter protocols aren’t adhered to, such as requiring sensitivity tests before using higher antibiotics.
The bacterial agent that causes typhoid fever, Salmonella Typhi (S Typhi), has antibiotic resistance, which is a worldwide health concern, particularly in low- and middle-income nations, according to Dr. Piyush Chaudhari, an infectious disease specialist at Jehangir Hospital. With travel-related cases documented in other nations, Pakistan has seen a notable increase in highly drug-resistant S Typhi. Other areas with high rates of antibiotic resistance include portions of South Asia, Africa, and some sections of Southeast Asia, Central and South America, and the Caribbean. While Salmonella is far less resistant to cephalosporins in India, it is undoubtedly a worry that is likely to grow if we don’t use antibiotics wisely.
