Culture positivity and antibiotic sensitivity pattern of typhoid fever in children aged 1 to 10 years: A 10-year retrospective study from a tertiary care centre of Eastern India

Background: Over the last few decades there has been a change in the trend of antibiotic sensitivity of Salmonella typhi from being sensitive to first line drugs like chloramphenicol, ampicillin and cotrimoxazole to developing multi-drug resistance. Most strains are presently sensitive to third generation cephalosporins and azithromycin but are developing resistance against fluoroquinolones.

Objectives: To determine the culture positivity and antibiotic sensitivity pattern of Salmonella typhi.

Method: This retrospective study was conducted at the Institute of Child Health, Kolkata from July 2014 to December 2020. Nine hundred and twenty children aged 1-10 years were included in the study, all with fever for more than 5 days. These children were suspected to have typhoid fever clinically i.e., with history, suggestive physical examination and after excluding other common febrile illnesses with routine blood test as per hospital protocol. Blood culture was done to confirm the diagnosis of typhoid fever, determine the proportion of blood culture positive cases and to find out the antibiotic susceptibility of Salmonella typhi in our hospital set up. Children were included in the study irrespective of prior antibiotic treatment.

Results: Of the 920 children, 55% were male and 45% were female; 15% cases were between 1-2 years of age and 85% were between 2-10 years of age; 53% cases were culture positive. In our study S. typhi was fully sensitive to ampicillin, chloramphenicol, cefixime, ceftriaxone and azithromycin. It was highly sensitive to cotrimoxazole. It was highly resistant to ciprofloxacin and nalidixic acid

Conclusions: There was complete sensitivity of Salmonella typhi to third generation cephalosporins and azithromycin. It was also sensitive to older, less commonly used antibiotics like chloramphenicol, cotrimoxazole and ampicillin. There was increased resistance to fluroquinolones.

Sri Lanka Journal of Child Health, 2023: 52(2): 169-174