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Cheaper drugs once again found effective for typhoid: study

By Our Special Correspondent

KOZHIKODE, FEB. 22. Drugs that had been found ineffective in the treatment of typhoid in North Kerala have regained their effectiveness on patients afflicted with the disease, according to a paper published by the doctors Lathi Nair and J. Sudarsana of the Kozhikode Medical College Hospital in the recent edition of the Calicut Medical Journal, (www.calicutmedicaljournal. org).

The electronic medical journal is published by the Calicut Medical College Alumni Association to give worldwide exposure to research done in the field of medicine by doctors in this region.

The report about easing of drug resistance to typhoid is based on a study of the sensitivity pattern of salmonella typhi, (S typhi, in doctors' jargon) that was isolated between 1995 and 2003. S typhi is the organism causing typhoid fever.

According to the study, multi drug resistance of the typhoid-causing organism had been decreasing. Multi drug resistant S typhi had been endemic in Kozhikode from 1989. But since 2002, incidence of multi drug resistance had decreased substantially.

The salmonella typhoid strains isolated between 1999 and 2003 were resistant to nalidixic acid and showed treatment failure with the drug ciprofloxacin. The patients given this drug did not respond to the treatment when they were administered the usual dose.

Chloramphenicol was the drug used for enteric fever (S.Typhi is the common etiological agent of the disease) since its introduction in 1948. But in the 1970s, resistance to this drug appeared and it was believed to have been behind the typhoid outbreaks in Latin America and Asia. In 1982, less than 15 per cent of the prevalent strains were chloramphenicol-resistant, but by 1988-89, multiple drug resistance to ampicillin, cotrimoxazole and chloramphenicol developed in 68.9 per cent of S typhi isolates in Kozhikode.

Fluroquinolones were the drug of choice for multiple drug resistant S typhi in Asia for the past decade. But the emergence of resistance raised a number of problems. Its higher cost was certainly a disadvantage.

The study indicated that S typhi has once started responding to ampicillin, amoxicillin, cotrimoxazole and chloramphenicol. This certainly has come as a major advantage for doctors and the patients alike since these drugs are cheaper.

Enteric fever, of which salmonella typhi is the most common etiological agent, is a major public health problem in the country accounting for more than three lakh cases a year. Countries such as Indonesia, India and Nigeria report high mortality rate due to typhoid fever, ranging from 12-32 per cent.

These countries share several common characteristics including rapid population growth, increased urbanisation, inadequate disposal of human wastes, inadequate water supply and overburdened healthcare system.

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