ArticlePLoS neglected tropical diseases2020
Response of extensively drug resistant Salmonella Typhi to treatment with meropenem and azithromycin, in Pakistan.
Article in PLoS neglected tropical diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.
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Who cites it
29 citing papers in PubMed, 1 synthesis or guideline pooled it, 60 citations in OpenAlex.
- Treatment of enteric fever (typhoid and paratyphoid fever) with cephalosporins.The Cochrane database of systematic reviews · 2022Pooled it
- Global trends and molecular epidemiology of Azithromycin-resistantOne health (Amsterdam, Netherlands) · 2026Article
- Prolonged fever in ESBL-producingRadiology case reports · 2026Article
- Meropenem Use and Challenges in Treating Severe Infections in Pakistan Amid Antimicrobial Resistance.Interdisciplinary perspectives on infectious diseases · 2026Review
- Adapting global guidelines to local contexts: optimising community-acquired pneumonia (CAP) specific prescribing in Pakistan to counter antimicrobial resistance.BMJ open respiratory research · 2025Article
- Poultry Food Assess Risk Model forFoods (Basel, Switzerland) · 2025Article
- Emergence of Azithromycin-resistant Salmonella Typhi in Southeast Asia: A systematic review.Pakistan journal of medical sciences · 2025Review
- Emergence of carbapenem-resistantFrontiers in microbiology · 2025Article
- The First Case of Antimicrobial-ResistantInfection and drug resistance · 2025Article
- Progress on the Global Research Agenda for Antimicrobial Resistance in Human Health in Pakistan: Findings and Implications.Infection and drug resistance · 2025Review
- Doripenem, Ertapenem, and Meropenem Sensitivity in Salmonella Typhi: A Cross-Sectional Study From Pakistan.Cureus · 2024Article
- Effectiveness of Oral Azithromycin in Treating Enteric Fever: A Hospital-Based Study on Pediatric Patients.Cureus · 2024Article
- Extensively drug-resistant Salmonella typhi Infection in Adults; Experience from A Tertiary Care Hospital.Pakistan journal of medical sciences · 2024Article
- Exploring the antimicrobial efficacy of Manuka honey against multidrug-resistant and extensively drug-resistantFuture microbiology · 2024Article
- Typhoid fever.Nature reviews. Disease primers · 2023Review
- RETRACTED: Empowering Low- and Middle-Income Countries to Combat AMR by Minimal Use of Antibiotics: A Way Forward.Antibiotics (Basel, Switzerland) · 2023Article
- Reporting of Azithromycin Activity against Clinical Isolates of Extensively Drug-Resistant Salmonella enterica Serovar Typhi.The American journal of tropical medicine and hygiene · 2023Article
- What Should We Be Recommending for the Treatment of Enteric Fever?Open forum infectious diseases · 2023Article
- Molecular Characterization of Extensively Drug ResistantInfection and drug resistance · 2023Article
- Characterization of a P1-bacteriophage-like plasmid (phage-plasmid) harbouringMicrobial genomics · 2022Article
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionSalmonella Typhi is one of the leading health problems in Pakistan. With the emergence of extensively drug resistant (XDR) Salmonella Typhi, treatment options are limited. Here we report the clinical manifestations and the response to treatment of patients with XDR Typhoid fever. The patients were treated with either Meropenem or Azithromycin or a combination of both.
methodsWe reviewed the records of culture confirmed XDR typhoid who visited Aga Khan University Hospital (AKUH), Karachi and Aga Khan Secondary Care Hospital, Hyderabad from April 2017 to June 2018. Symptoms developed during disease, unplanned treatment extension and complications developed while on antimicrobials was recorded. Means with standard deviation were calculated for duration of treatment, time to defervescence, and cost of treatment.
resultsRecords of 81 culture confirmed XDR typhoid patients admitted at the AKU hospitals were reviewed. Most, (n = 45; 56%) were male. Mean age of the cases was 8.03 years with range (1-40). About three quarter (n = 66) of the patients were treated as inpatient. Fever and vomiting were the most common symptoms at the time of presentation. Oral azithromycin alone (n = 22; 27%), intravenous meropenem alone (n = 20; 25%), or a combination of azithromycin and meropenem (n = 39; 48%) were the options used for treatment. Average (95% confidence interval) time to defervescence was 7.1(5.5-8.6), 6.7(4.7-8.7), and 6.7(5.5-7.9) days for each treatment option respectively whereas there were 1,0 and 3 treatment failures in each treatment option respectively. Average cost of treatment per day for azithromycin was US$5.87 whereas it was US$88.46 for meropenem.
conclusionPatients treated with either Azithromycin, Meropenem alone or in combination showed similar time to defervescence. Because of the lower cost of azithromycin, it is preferable in lower socio-economic areas. Background estimates for power calculation can be made for more robust clinical trials using this observational data.
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