To the Editor.—We read with interest the recent presentation and review of a case of Salmonella typhi infection in a pregnant woman returning from India. Dr Zenilman1 discussed multidrug resistance (MDR) in S typhi and reinforced the general view that fluoroquinolones are effective first-line therapy in the treatment of such infections.
We recently cared for a 52-year-old man who had arrived 1 week previously from the Punjab region of northern India. He had had fever and headache for 6 days. Blood cultures grew S typhi, and he was treated with oral ciprofloxacin (500 mg twice a day at presentation, increasing to 750 mg twice a day on day 3). Despite some clinical improvement he remained febrile after 17 days of treatment. Ceftriaxone, 1 g once daily, was added to his regimen, and his fever resolved within 3 days.
Atkins BL, Gottlieb T. Emerging Drug Resistance and Vaccination for Typhoid Fever. JAMA. 1998;279(8):579. doi:10.1001/jama.279.8.579
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