Drug resistance making typhoid tough to treat
New Delhi, April 2017:
Resistance to antibiotics is making it difficult to treat even milder illnesses like typhoid, the incidence of which has gone up significantly in Delhi over the past few days due to increased consumption of contaminated food and water. Doctors said that while earlier oral drugs could cure most patients, they now needed to give injectable antibiotics to 20-30% of the patients to treat typhoid symptoms. "In few cases, even the injectable drug doesn't help and we have to give add-on antibiotics to bring down fever, one of the characteristic symptoms of typhoid," said Dr Rommel Tickoo, senior consultant, internal medicine, at Max Hospital Saket.
TOI spoke to doctors at Apollo, Sir Ganga Ram (SGRH) and Safdarjung hospitals who confirmed the trend. Over-the-counter use of antibiotic is a major culprit, said Dr B K Tripathi, professor of medicine at Safdarjung Hospital. "Many patients take anti-fever drugs and even antibiotics on their own to treat typhoid symptoms. When it doesn't help, they rush to hospital. In many cases, both we have to put patients on both injectable drugs and add-on antibiotics," Dr Tripathi said.
Typhoid, a major public health infection, is caused by Salmonella typhi bacteria and leads to symptoms such as persistently high fever, nausea, headache and abdominal pain. Earlier most people could be treated at home, but now more need to be hospitalised, increasing the cost of treatment, said doctors. "In rare cases, treatment failure can cause severe complications and death even," a doctor said.
According to Dr Atul Kakar, vice-chairperson of medicine department at SGRH, multi-drug resistance has is an emerging public health crisis. "When I was a student, we used to give chloramphenicol - a type of antibiotic - to treat typhoid. Its use was discontinued later due to high toxicity. Recently, we have observed that the same drug is sensitive to the typhoid-causing bacteria when new drugs fail. This means that we may have to go back in time and use older drugs with known side-effects if the drug-resistance pattern continues to grow like this," he said.
A research published in Journal of Global Infectious Diurnal of Global Infectious Diseases in 2010 by Safdarjung doctors had pre-empted the problem. Ciprofloxacin, they wrote, has become a norm for treating enteric fever or typhoid, but in future novel molecular substitutions (new antibiotics) may become frequent owing to irrational use of ciprofloxacin in human and veterinary therapeutics, in a population endemic with nalidixic acid-resistant strains. "The therapeutics of ciprofloxacin-resistant enteric fever narrows down to third and fourth generation cephalosporins, azithromycin, tigecycline and penems. The first-line antimicrobials ampicillin, chloramphenicol and cotrimoxazole need to be reconsidered," the microbiologists predicted further.
Preventing infections is equally important. Typhoid, for example, spreads from person to person by food and water that are contaminated with traces of infected faeces or urine. Dr Suranjit Chatterjee, senior consultant (internal medicine) at Apollo Hospital, said improved sanitation, hand hygiene and availability of clean drinking water could reduce infection rates significantly.
Apart from typhoid, medical experts say, drug resistance is also becoming a major problem in treatment of pneumonia, urinary tract infection and tuberculosis. "Over-the-counter use of antibiotics must be stopped. The government must take steps to restrict their sale so that they can be used only when needed," Dr Tickoo said.