To the Editor: Based on the study of typhoid fever in the United States from 1996 to 2006 by Dr Lynch and colleagues,1 it may not be appropriate to continue to recommend treatment with a fluoroquinolone (as the authors did) if nalidixic acid resistance and decreased susceptibility to ciprofloxacin is of concern, especially for persons who have visited South Asia. Almost 70% of the patient population in this study had visited India, Pakistan, or Bangladesh. Also, not all fluoroquinolones have the same effectiveness against enteric fever.2,3 At Patan Hospital in Kathmandu, Nepal, where 5 to 10 patients with possible enteric fever may be seen each day during the summer months, ciprofloxacin is avoided for empirical treatment of enteric fever. Azithromycin is often used.4
Basnyat B. Typhoid Fever in the United States and Antibiotic Choice. JAMA. 2010;303(1):34–35. doi:10.1001/jama.2009.1935
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