To the Editor: Based on the study of typhoid fever in the United States from 1996 to 2006 by Dr Lynch and colleagues,1 it may not be appropriate to continue to recommend treatment with a fluoroquinolone (as the authors did) if nalidixic acid resistance and decreased susceptibility to ciprofloxacin is of concern, especially for persons who have visited South Asia. Almost 70% of the patient population in this study had visited India, Pakistan, or Bangladesh. Also, not all fluoroquinolones have the same effectiveness against enteric fever.2 - 3 At Patan Hospital in Kathmandu, Nepal, where 5 to 10 patients with possible enteric fever may be seen each day during the summer months, ciprofloxacin is avoided for empirical treatment of enteric fever. Azithromycin is often used.4
Moreover, it is not known with what antibiotics these US patients were treated or what was their hospital course, in order to determine effectiveness. It seems likely that they received intravenous ceftriaxone and not a fluoroquinolone.
In addition, although this group of patients was limited to those with typhoid fever, for many clinicians typhoid and paratyphoid fever are confusingly interchangeable. Hence, a comment on the increasing incidence of paratyphoid fever (even in US travelers5 ) and the ineffectiveness of the present typhoid vaccine against paratyphoid organisms would have been useful.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Journal of American Medical Association editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.