A 5-year-old girl is diagnosed with enteric fever. She has no clinical improvement after 5 days of cefixime. Blood culture isolates Salmonella typhi that is sensitive only to chloramphenicol and cotrimoxazole, and resistant to ampicillin, fluoroquinolones, and third-generation cephalosporins. What is the CORRECT classification and management?
- A Multidrug-resistant (MDR) typhoid; treat with azithromycin as first choice for uncomplicated cases ✓
- B Multidrug-resistant (MDR) typhoid; treat with oral chloramphenicol
- C Extensively drug-resistant (XDR) typhoid; treat with azithromycin
- D XDR typhoid; intravenous meropenem is the only option
Explanation
Multidrug-resistant (MDR) Salmonella typhi is defined as resistance to all three first-line drugs: ampicillin, cotrimoxazole, and chloramphenicol — this isolate is sensitive to chloramphenicol and cotrimoxazole so it does not fit MDR. However, resistance to fluoroquinolones and third-generation cephalosporins defines XDR typhoid (extensively drug-resistant), which is a major outbreak strain in Pakistan. XDR typhoid is resistant to all the above PLUS fluoroquinolones and third-generation cephalosporins. The treatment for XDR typhoid is azithromycin for uncomplicated cases or carbapenems for complicated cases.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.