Published Date: 2001-03-07 23:50:00
Subject: PRO> Typhoid fever - Kenya (Embu) (03)
Archive Number: 20010307.0465
TYPHOID FEVER - KENYA (EMBU) (03)
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See Also
Typhoid fever - Kenya (Embu) (02) 20010303.0427Typhoid fever? - Kenya (Embu): RFI 20010223.0348
Date: 5 Mar 2001 10:03:06 +0100
From: Prof. P. M. Shah <shah@em.uni-frankfurt.de>
Experience as reported by C. Rodrigues, A. Mehta, and V. R. Joshi.
Nalidixic acid-resistant _Salmonella typhi_ in Mumbai. The National Medical
Journal of India 12 (2):88, 1999, shows that recently typhoid fever is
responding very slowly to ciprofloxacin (and probably to other quinolones
as well), if the strains are resistant or less sensitive to nalidixic acid.
An alternative to quinolones should be looked for in such instances.
--
Pramod M. Shah
Frankfurt am Main
Germany
<shah@em.uni-frankfurt.de>
[Quinolones act by inhibiting the bacterial DNA gyrase, thereby preventing
relaxation of the excessive (+)supercoiling of DNA that is induced by
strand separation during transcription and replication. Bacterial
resistance is often related to mutations in the A subunit of the DNA gyrase
(the subunit which cuts the strands of DNA) resulting in a decreased
ability of the quinolones to inhibit enzymatic activity. Nalidixic acid is
an early-generation quinolone that is rapidly excreted and useful primarily
as an antibacterial agent for urinary tract infections. Ciprofloxacin is
one of several available 6-fluoro derivatives that are more than 1000-fold
more potent than nalidixic acid. This communication suggests that the
problem of _Salmonella typhi_ fluoroquinolone resistance reported in Kenya
(see ProMED-mail reference (02) cited above) is becoming widespread.
Readers are referred to the following for additional information about
therapy of antibiotic-resistant _S. typhi_ infections.
Chinh, NT et al., A randomized controlled comparison of azithromycin and
ofloxacin for treatment of multidrug-resistant or nalidixic acid-resistant
enteric fever, Antimicrob Agents Chemother. 44(7):1855-9, 2000. - Mod.ES
.............................es/pg/ds
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