Drug resistant enteric fever is a harsh reality; with resistance to fluoroquinolones, cotrimoxazole, ampicillin, amoxycillin on the rise. So what is the place of aminoglycosides in the treatment of enteric fever? Could you please cite recent research done in this area? Thanks in advance !
for typhoid fever, antibiotics need to be given for 12-14 days, at least, to completely eradicate the pathogen. Aminoglycosides are not given for so long time due to risk of ototoxicity and nephrotoxicity. Besides, efficacy is also not good. Ceftriaxone or Amoxiclav should be reasonably good. Even chloramphenicol works in most cases, but it can be very toxic at times.
Review Article
Current Trends in the Management of Typhoid Fever
Lt Gen SP Kalra AVSM Bar*
, Lt Col N Naithani+, Col SR Mehta VSM#
, Sqn Ldr AJ Swamy**
MJAFI 2003; 59 : 130-135
Aminoglycosides can lead to hearing loss, cardiac toxicity, renal toxicity and exacerbate weakness in patients with myasthenia gravis... Ceftriaxone or Amoxiclav could be a good option.
There is no place for aminoglycosides in this setting. For typhoid fever, quinolones are state of the art. Most other enteric infections don´t require antibiotics, but may rather worsen the clinical condition.
Aminoglycosides are ineffective for intracellular organisms (as Salmonella often is) and therefore as pointed out by Easow, do not lead to a clinical cure. Quinolone resistance is over 50% in the Indian sub-continent so Ceftriaxone is the current drug of choice.
Even in Africa the treatment is not aminoglycosides and may be ceftriaxone is effective in case of resistance
Quinolone is the drug of choice even in multidrug resistant typhoid fever not aminoglycosides
I had never used aminoglycosides in treatment of enteric fever. In few occasions, chloramphenicol was still effective. Ceftriaxone is effective but very expensive. Quinolones are used commonly even without waiting for culture results.
Thanks Mostafa Ragheb for this strong comment
So no place for aminoglycosides in treatment of enteric fever
Azithromycin is considered first line treatment .Patient's recent travel history is important.Aminoglycosidesare not a good choice.,.Regards.
Dear Preet Shah, in a recent retrospective cohort study in Spain (2015), they recommended initial treatment with third-generation cephalosporin or azithromycin.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616427/
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