azithromycin is increasingly used for the empirical treatment of enteric fever
Notes:
for many decades, antibiotics such as chloramphenicol, ampicillin, and cotrimoxazole were used for treating enteric fever
emergence of multiple-drug-resistant (MDR) Salmonella strains, which are resistant to chloramphenicol, ampicillin, and cotrimoxazole, has changed treatment options (2)
second-line antibiotics like the fluoroquinolones (ciprofloxacin, ofloxacin, perfloxacin), third-generation cephalosporins (ceftriaxone, cefotaxime, cefixime), and azithromycin are often now used for treating MDR typhoid fever
infections with isolates susceptible to nalidixic acid (prototype fluoroquinolone) respond extremely well to fluoroquinolones
the extensive use of fluoroquinolones has since led to the emergence of intermediate and fully fluoroquinolone resistant strains
a systematic review concluded that (1):
azithromycin appears better than fluoroquinolone drugs in populations that included participants with drug-resistant strains
azithromycin may perform better than ceftriaxone
azithromycin is increasingly used for the empirical treatment of enteric fever
but widespread use of this drug in many parts of South Asia today may rapidly lead to development of resistance, highlighting the importance of good microbiological surveillance
some authors have advocated the addition of doxycycline for suspected enteric fever cases in regions of South Asia with high incidence of Rickettsia spp
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