Ceftriaxone-resistant typhoid cases in city raise concerns among doctors

Time of India

16 hours ago

Pune: Doctors in the city have reported at least two cases of antibiotic resistance in typhoid-causing bacteria, with some instances of Salmonella typhi not responding to ceftriaxone, a commonly used treatment for the infection in India, which specialists attributed to the drug's rampant and irrational use.
"Culture reports of at least two patients this year have confirmed ceftriaxone resistance. Fortunately, the bacteria is still sensitive to azithromycin, and we were able to treat these patients successfully with that drug," Dr Ameet Dravid, a senior infectious disease specialist, told TOI.
The doctors warned that while the number of resistant cases is currently low, the trend was worrying. "Once resistance emerges, it can spread rapidly.
Today it is two cases, tomorrow it can be 10 or 20. This can happen because bacteria are capable of transferring resistance genes to each other. Till last year, I had not seen any ceftriaxone-resistant typhoid. But this year, we have begun to see a couple of culture-proven cases, which is an early but worrying sign," Dr Dravid said.
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Dr Sujata Rege, consultant – infectious diseases, Symbiosis University and Jupiter hospitals, said, "We are now beginning to see occasional cases of Salmonella typhi not responding well to ceftriaxone, which is usually our first-line of treatment.
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Such samples are being sent for molecular testing to CMC Vellore. There was an outbreak of ceftriaxone-resistant typhoid in Gujarat, and while the numbers here are still low, resistance is emerging.
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She said in such cases, doctors often needed to switch to azithromycin, but it was important to preserve this drug by avoiding its rampant use for routine respiratory infections. "Interestingly, some older drugs such as co-trimoxazole (Septran) and chloramphenicol (which were long abandoned) are showing renewed sensitivity against typhoid.
This is worrying because it reflects a shift in resistance patterns that were earlier mainly seen in Pakistan and Afghanistan, but are now appearing in India as well.
Unless blood cultures are done at the outset, resistance is missed. Many patients are started on antibiotics like cefixime or ceftriaxone without cultures, which lowers our ability to track and respond to resistance trends. Blood culture remains the gold standard for diagnosis and should ideally be performed before any antibiotic is prescribed," Dr Rege said.
Dr Mahesh Kumar Manohar Lakhe, infectious diseases expert, Sahyadri Hospitals, told TOI, "In past, drugs like ciprofloxacin and levofloxacin worked well against typhoid. But over the last two to three decades, resistance to these agents has increased sharply. We then started relying more on third-generation cephalosporins like ceftriaxone. Of late, however, we are beginning to see a few cases of ceftriaxone-resistance as well.
I have personally treated a culture-proven ceftriaxone-resistant case in a patient who had travelled from Vasai near Mumbai."
Dr Lakhe said, "While the numbers are very small, it indicates the beginning of a trend that has already been reported more widely in countries like Pakistan and Bangladesh. Colleagues from Delhi, Kolkata, Chennai and other regions have also reported encountering such cases, though much of this remains unpublished data at the moment."
Dr Renu Bharadwaj, retired professor and microbiologist, BJ Medical College and Sassoon Hospital, said, "Antibiotic resistance in typhoid is not only due to misuse of drugs in humans but also because of rampant use of antibiotics in poultry and livestock. Birds are routinely given antibiotics in feed, which means Salmonella circulating in animals is already carrying resistance genes. When such strains infect humans, they are resistant from the start, even if the patient has never received those antibiotics before.
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She said, "Another major issue is irrational prescribing practices in hospitals. Many doctors start patients on higher antibiotics like ceftriaxone without doing a blood culture or antibiotic sensitivity test. Overuse in ICUs and wards creates an environment where resistance genes circulate and transfer to Salmonella. As a result, when a patient truly needs ceftriaxone, the infection may not respond. Unless stricter protocols are followed (such as mandating sensitivity reports before higher antibiotics are used), we risk losing our last-line drugs.
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Dr Piyush Chaudhari, infectious disease specialist at Jehangir Hospital said, "Antibiotic resistance in Salmonella Typhi (S Typhi), the bacteria that causes typhoid fever, is a global health concern, particularly in low- and middle-income countries. Pakistan has experienced a significant increase in extensively drug-resistant S Typhi, with travel-associated infections reported in other countries. Other regions with high rates of antibiotic resistance include parts of South Asia, Africa, and certain areas of Southeast Asia, Central and South America, and the Caribbean.
Although resistance in Salmonella is much less in India when it comes to Cephalosporins but it's definitely a concern which is likely to increase if we don't use antibiotics appropriately."
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