Emergence of Azithromycin-resistant Salmonella Typhi in Southeast Asia: A systematic review.

Objective: To systematically review the literature on the epidemiology, antimicrobial resistance, and control strategies for typhoid fever, focusing on Southeast Asia, where the disease burden and emergence of drug-resistant strains are significant. Method: A systematic review was used, and twenty-five manuscripts fulfilling the inclusion criteria were included. Only human studies affected by typhoid fever were included, including systematic reviews, narrative reviews, meta-analyses, cross-sectional studies, original studies, editorials, or Commentary. Manuscripts were searched and reviewed according to PRISMA guidelines. From 2006 to 2024, six reliable sources, including PubMed, Web of Science, Scopus, Cochrane Library, Google Scholar, and Embase, were evaluated. Results: Typhoid fever remains a significant global health burden, particularly in regions with poor sanitation. In 2019, there were about 9.2 million cases and 110,000 deaths, with the highest rates in the Eastern Mediterranean, Africa, and Southeast Asia. Treatment options exist, and the emergence of drug-resistant strains, including those resistant to first-line antibiotics like azithromycin, poses a serious threat. The misuse of antibiotics primarily causes this resistance. Effective control strategies require improved sanitation and hygiene, widespread vaccination, prudent antibiotic use and stewardship programs, enhanced surveillance, and drug resistance monitoring. Conclusion: Typhoid, caused by Salmonella typhi, remains a health threat in Southeast Asia due to poor sanitation and limited access to clean water. Addressing this requires improved sanitation, vaccination, careful antibiotic use, and intense surveillance to combat antibiotic-resistant strains.