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Salmonella enterica serovar Typhi de sensibilité diminuée à la ciprofloxacine

Abstract : The use of fluoroquinolone (FQ) as first line therapy for typhoid fever should be reconsidered because of the emergence of Salmonella Typhi and Paratyphi A strains with decreased susceptibility to FQ, mainly from Asia. Relapse can occur when ciprofloxacin MIC is over 0.12 mg/l, as illustrated by our case report. Azithromycin can be used successfully for patients infected with reduced ciprofloxacin susceptibility isolates. Literature review led us to suggest a new therapeutic strategy for uncomplicated typhoid fever, the antibiotic was chosen according to nalidixic acid susceptibility and ciprofloxacin MIC of the strain. High-dose intravenous ceftriaxone (4 g per day) is always efficient in first line therapy. Depending on FQ susceptibility testing results, it is relayed by oral therapy with a FQ (ciprofloxacin 500 mg bid for 7 days) if the isolate has maintained susceptibility, or azithromycin (1 g first day and 500 mg per day, 7 days) if the isolate is resistant to nalidixic acid or has a ciprofloxacin MIC superior to 0.12 mg/l.
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V Gaborieau, François-Xavier Weill, B Marchou. Salmonella enterica serovar Typhi de sensibilité diminuée à la ciprofloxacine. Médecine et Maladies Infectieuses, Elsevier Masson, 2010, 40 (12), pp.691-5. ⟨10.1016/j.medmal.2010.06.009⟩. ⟨pasteur-01133825⟩

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