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J Med Microbiol 56 (2007), 277-279; DOI: 10.1099/jmm.0.46773-0
© 2007 Society for General Microbiology
ISSN 1473-5644

Case Report

Ciprofloxacin treatment failure in a case of typhoid fever caused by Salmonella enterica serotype Paratyphi A with reduced susceptibility to ciprofloxacin

Tzonyo Dimitrov1, Edet E. Udo2, Osama Albaksami3, Abdul A. Kilani4 and El-Din M. R. Shehab4

1 Department of Medical Laboratories, Microbiology Section, Infectious Diseases Hospital, PO Box 4710, Safat 13048, Kuwait

2 Department of Microbiology, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110, Kuwait

3 Department of Pediatrics, Infectious Diseases Hospital, PO Box 4710, Safat 13048, Kuwait

4 Department of Medicine, Infectious Diseases Hospital, PO Box 4710, Safat 13048, Kuwait

Correspondence
Tzonyo Dimitrov
dimitrov_varn90{at}hotmail.com

Received 11 June 2006
Accepted 6 October 2006

This report describes a case of ciprofloxacin treatment failure in a patient with enteric fever caused by Salmonella enterica serotype Paratyphi A. The organism was isolated from a blood culture from a patient who was treated with oral ciprofloxacin (500 mg every 12 h) for 13 days. The organism showed reduced susceptibility to ciprofloxacin (MIC 0.75 µg ml–1) and was resistant to nalidixic acid. The patient was then placed on intravenous ceftriaxone (1 g every 12 h) and responded within 3 days. The patient was discharged after 9 days on ceftriaxone with no relapse on follow-up. This case adds to the increasing incidence of treatment failures with ciprofloxacin in typhoid fever caused by typhoid salmonellae with reduced susceptibility to ciprofloxacin. It also highlights the inadequacy of current laboratory methods for fluoroquinolone susceptibility testing in adequately predicting in vivo activity of ciprofloxacin against typhoid salmonellae and supports calls for new guidelines for fluoroquinolone susceptibility testing of these organisms.

Abbreviations: CLSI, Clinical and Laboratory Standards Institute.




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