ASSESSMENT OF CLINICAL EFFICACY OF AZITHROMYCIN IN CULTURE POSITIVE SALMONELLA TYPHI
DOI:
https://doi.org/10.71000/1k9tc219Keywords:
Azithromycin, Enteric Fever, Salmonella Typhi, Antibiotic Resistance, Bacteremia, Pakistan, Typhoid FeverAbstract
Background: Enteric fever remains a significant public health concern in low- and middle-income countries, particularly in South Asia. Caused by Salmonella enterica serovar Typhi, it has become increasingly challenging to treat due to the emergence of multidrug-resistant (MDR) strains. Azithromycin has emerged as a promising alternative, owing to its favorable pharmacokinetics and intracellular penetration.
Objective: To determine the clinical and microbiological efficacy of oral azithromycin in patients with culture-positive Salmonella Typhi infection.
Methods: This quasi-experimental study was conducted in the General Medicine Department of Khyber Teaching Hospital, Peshawar, over six months. A total of 146 patients aged 18–60 years with blood culture-confirmed Salmonella Typhi were enrolled using consecutive non-probability sampling. Each participant received azithromycin 10 mg/kg/day orally for seven days. Efficacy was defined as the resolution of fever and constitutional symptoms along with a negative blood culture on day seven. Data were analyzed using SPSS v23, with stratification and post-stratification chi-square tests to assess effect modifiers.
Results: Azithromycin demonstrated an overall efficacy rate of 82.2%. Among female patients, efficacy reached 92.3%, while in males it was 84%. Patients without comorbidities such as diabetes, hypertension, or dyslipidemia exhibited higher response rates. No serious adverse effects were reported. The drug was well tolerated across all demographics.
Conclusion: Azithromycin is an effective and safe oral antibiotic for treating uncomplicated typhoid fever, particularly in regions with high prevalence of antimicrobial resistance. These findings support its inclusion as a first-line therapy in local treatment protocols, although continued surveillance of resistance patterns is warranted.
References
Fasih F, Fatima A, Baig S, Naseem S, Tauheed MM, Gohar H. Antimicrobial susceptibility of bacteraemic isolates of Salmonella enterica serovar typhi and paratyphi infection in Pakistan from 2017-2020. J Pak Med Assoc. 2023;73(3):505-10.
Sahai N, John Jacob J, Kumar Arunachalam D, Kumar Das B, Kapil A, Pandey S, et al. Antimicrobial susceptibility trends of S. Typhi and S. Paratyphi in a post-COVID-19 pandemic India, from a multicenter surveillance network. Sci Rep. 2025;15(1):13777.
Tagg KA, Kim JY, Henderson B, Birhane MG, Snyder C, Boutwell C, et al. Azithromycin-resistant mph(A)-positive Salmonella enterica serovar Typhi in the United States. J Glob Antimicrob Resist. 2024;39:69-72.
Octavia S, Chew KL, Lin RTP, Teo JWP. Azithromycin-Resistant Salmonella enterica Serovar Typhi AcrB-R717Q/L, Singapore. Emerg Infect Dis. 2021;27(2):624-7.
Chapagain RH, Adhikari S, Bhattarai T, Basaula Y, Bhattarai S. Burden of enteric fever and antibiotic sensitivity in Nepalese Children Prior to Typhoid Vaccine in National Immunization Program. J Nepal Health Res Counc. 2023;21(2):297-302.
Kumar H, Manoharan A, Anbarasu A, Ramaiah S. Emergence of sulphonamide resistance in azithromycin-resistant pediatric strains of Salmonella Typhi and Paratyphi A: A genomics insight. Gene. 2023;851:146995.
Veeraraghavan B, Pragasam AK, Ray P, Kapil A, Nagaraj S, Perumal SPB, et al. Evaluation of Antimicrobial Susceptibility Profile in Salmonella Typhi and Salmonella Paratyphi A: Presenting the Current Scenario in India and Strategy for Future Management. J Infect Dis. 2021;224(Supple 5):S502-s16.
Ahmad M, Shah N, Siddiqui MA. Frequency and Antibiotics Sensitivity Pattern of Culture-Positive Salmonella Typhi in Children. J Coll Physicians Surg Pak. 2023;33(3):303-7.
Alexander V, George JT, Paul JS. Increasing azithromycin resistance in patients with enteric fever: Cause for concern. Trop Doct. 2024;54(3):294.
da Silva KE, Tanmoy AM, Pragasam AK, Iqbal J, Sajib MSI, Mutreja A, et al. The international and intercontinental spread and expansion of antimicrobial-resistant Salmonella Typhi: a genomic epidemiology study. Lancet Microbe. 2022;3(8):e567-e77.
Tariq H, Samad A, Jan S, Mazhar Asjad HM, Khan JA, Bugti FS, et al. Molecular characterization of extensively drug-resistant Salmonella serovar Typhi in patients with gastrointestinal complications in Quetta, Pakistan. Pak J Pharm Sci. 2025;38(4):1354-67.
Safdar N, Malik N, Nizamuddin S, Rasool A. Pan Drug-Resistant Salmonella Serovar Typhi Septicaemia In A Child: A Case Report. J Pak Med Assoc. 2023;73(9):1909-11.
Khattak Z, Aala R, Sani N, Khan SA, Khan S, Shah SA, et al. Prevalence and antimicrobial susceptibility of Salmonella enterica Typhi in febrile patients: a cross-sectional study. J Infect Dev Ctries. 2025;19(6):904-12.
Jabeen K, Saleem S, Nizamuddin S, Arshad F, Jahan S, Hasnain F, et al. Reporting of Azithromycin Activity against Clinical Isolates of Extensively Drug-Resistant Salmonella enterica Serovar Typhi. Am J Trop Med Hyg. 2023;108(5):942-7.
Shahid S, Mahesar M, Ghouri N, Noreen S. A review of clinical profile, complications and antibiotic susceptibility pattern of extensively drug-resistant (XDR) Salmonella Typhi isolates in children in Karachi. BMC Infect Dis. 2021;21(1):900.
Carey ME, Jain R, Yousuf M, Maes M, Dyson ZA, Thu TNH, et al. Spontaneous Emergence of Azithromycin Resistance in Independent Lineages of Salmonella Typhi in Northern India. Clin Infect Dis. 2021;72(5):e120-e7.
Chidambaram Y, Dhas CJ, Juhi R, Petchiappan V, Sujithkumar S. Tracking the shift in enteric fever trends and evolving antibiotic sensitivity patterns. Ghana Med J. 2024;58(1):86-90.
Posen HJ, Wong W, Farrar DS, Campigotto A, Chan T, Barker KR, et al. Travel-associated extensively drug-resistant typhoid fever: a case series to inform management in non-endemic regions. J Travel Med. 2023;30(1).
Tanmoy AM, Hooda Y, Sajib MSI, Rahman H, Sarkar A, Das D, et al. Trends in antimicrobial resistance amongst Salmonella Typhi in Bangladesh: A 24-year retrospective observational study (1999-2022). PLoS Negl Trop Dis. 2024;18(10):e0012558.
Chattaway MA, Langridge GC, Wain J. Salmonella nomenclature in the genomic era: a time for change. Sci Rep. 2021;11(1):7494-9.
Meiring JE, Khanam F, Basnyat B, Charles RC, Crump JA, Debellut F, et al. Typhoid fever. Nat Rev Dis Primers. 2023;9(1):71-5.
Uzair M, Wali S, Rehman AU, Ahmad A, Rafique MH, Nadeem MB. Clinical Efficacy of Oral Azithromycin Versus Other Antimicrobial Drugs in the Treatment of Typhoid Patients Across All Age Groups: A Systematic Review of Randomized Controlled Trials. J Ayub Med Coll Abbottabad. 2024;36(3):642-50.
Ullah I, Khan KS, Mehmood Q, Tahir MJ, Malik MI, Ahmed A, et al. Irrational use of azithromycin in typhoid endemic areas: A challenge on multidrug-resistant typhoid treatment. Trend Infect Glob Health. 2021;1(2):37-40.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Saif Ullah, Abdul Basit, Mian Imad Ahmed, Zahid Mohammad Wazir, Sohrab Khan, Zahid Ullah, Abuzar Ali (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
