Changing spectrum of antibiotic sensitivity in enteric fever.

AIMS AND OBJECTIVES The study was designed to analyze clinical profile and Antibiotic sensitivity pattern in case of culture positive typhoid fever and compare response of quinolones in vitro and in vivo. METHODOLOGY Forty eight cases of culture positive enteric fever presented in outpatient and emergency department of Kathmandu Medical College, Sinamangal, and Kathmandu were included in the study. Sensitivity pattern of isolates from blood culture was done by antibiotic disc diffusion method and this was compared with clinical response. RESULTS Response was based on Fever Clearance Time (FCT) and it was found that mean FCT was 3.58 days with standard deviation of 1.84 .Comparison was made separately for FCT >or=5 days and it was found that vomiting as the symptom and stool occult blood positive as the investigation to predict prolong FCT. Nalidixic acid as compared with other quinolones showed that other quinolones (ciprofloxacin, ofloxacin) are effective even in Nalidixic acid resistant cases when FCT was taken as the criteria of response, and it doesn't include the relapse rate. CONCLUSION Enteric fever is one of the leading causes of fever in Nepal. The diagnosis in most of the cases is done empirically by clinical features, but culture and sensitivity of blood or bone marrow is the gold standard way of diagnosis and providing treatment. The antibiotic sensitivity pattern is changing and resistance cases are emerging with indiscriminate use of drugs.