JMM Editor’s Choice: Increasingly limited options for the treatment of enteric fever in travellers returning to England

Posted on October 20, 2021   by Microbiology Society

In this blog, Dr Norman Fry discusses ‘Increasingly limited options for the treatment of enteric fever in travellers returning to England, 2014–2019: a cross-sectional analytical study’ which he selected as Editor’s Choice in the Journal of Medical Microbiology after its publication in August.
 

The clinical presentation of enteric fever, also known as typhoid fever, when caused by Salmonella enterica serovar Typhi and paratyphoid fever, when due to S. enterica serovar Paratyphi, is often non-specific. Prevention of complications requires timely initiation of effective antimicrobial therapy. Therefore, antibiotics are often initiated empirically on suspicion. To be effective, clinicians and microbiologists should know which antibiotics are optimal prior to full susceptibility profiles becoming available.
Trent Herdman and colleagues set out to determine which antibiotics should be used empirically when patients present with enteric fever on return from travel. The ability to track and inform change of choice of empirical treatment, if required, is vital. The rates of non-susceptibility of S. Typhi and S. Paratyphi to single antibiotics (i.e., ciprofloxacin); multiple antibiotics (multidrug resistant and fluoroquinolones) and the rise of extended drug-resistant phenotypes were concerning. The majority of imported isolates remain sensitivitive to third-generation cephalosporins and no evidence of azithromycin resistance was found. Thus, the authors conclude that these agents remain suitable first-line treatment for cases of suspected enteric fever returning from travel.

Increasingly limited options for the treatment of enteric fever in travellers returning to England, 2014–2019: a cross-sectional analytical study

Enteric fever (typhoid and paratyphoid) infections diagnosed in developed countries are predominantly acquired during travel to endemic countries. Managing patients and outbreaks of enteric fever effectively depends upon monitoring global patterns of antibiotic resistance. We characterised the antibiotic resistance profiles of Salmonella Typhi and Paratyphi isolates in England from 2014 to 2019. Compared to an earlier survey, the risk of resistance to key antibiotics has increased in infections acquired in Africa and Asia (particularly Pakistan, where extensively drug-resistant typhoid is now endemic). This narrows the treatment options. We used this study to inform the national prescribing recommendations.

We spoke with the author Trent Herdman to find out more:

What is your institution and how long have you been there?

UK Health Security Agency, previously known as Public Health England, for the past two years, through the UK Field Epidemiology Training Programme.

What is your research area?

Field Epidemiology and Infectious Disease Medicine

What inspired you to research this topic?

Antimicrobial resistance is a global concern and requires global attention and solutions. This project presented an opportunity to use routinely collected data to offer insight into how we understand and treat an important health problem.

What is the most rewarding part of your research?

The chance to inform and improve patient care, and to see how medicine and science change over time.

What would you be doing if you weren't a scientist?

Probably still wondering about how the world works.