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Revised ciprofloxacin breakpoints for Salmonella: Is it time to write an obituary?

Publication Type : Journal Article

Thematic Areas : Medical Sciences

Publisher : Journal of Clinical and Diagnostic Research

Source : Journal Clinical Diagnostic Research, Volume : 7 | Issue : 11, 2013

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Campus : Kochi

School : School of Medicine

Department : Microbiology

Year : 2013

Abstract : Objectives: To determine the minimum inhibitory concentration of ciprofloxacin among 50 blood stream isolates of Salmonella enterica. Material and Methods: A total of 50 consecutive isolates of Salmonella enterica were tested for susceptibility to antimicrobials using the Kirby Bauer disk diffusion method. Minimum inhibitory concentrations were determined using Hi-Comb strips. All results were interpreted according to the CLSI guidelines. Results: Of the 50 isolates 70%were Salmonella Typhi, 4% Salmonella paratyphi A, 2% Salmonella paratyphi B and the remaining 10% were identified only as Salmonella species. Using the CLSI 2011 breakpoints for disc diffusion, 86% (43/50) were resistant to nalidixic acid(NA), 22% (11/50) to ciprofloxacin, 12% to azithromycin, 6% to cotrimoxazole, 4% to ampicillin and 1% to chloramphenicol. The MIC50 and MIC90 of ciprofloxacin for S.Typhi were 0.181 μg/mL and 5.06 μg/mL respectively. While the same for S. paratyphi A was 0.212μg/mL and 0.228μg/mL respectively. None of the isolates were multi drug resistant and all were susceptible to ceftriaxone. Using the CLSI 2012 revised ciprofloxacin breakpoints for disc diffusion (31mm) MIC (0.06 μg/mL), 90% (45/50) of these isolates were found to be resistant. Conclusion: MIC's of ciprofloxacin should be reported for all salmonella isolates and should be used to guide treatment. Blindly following western guidelines for a disease which is highly endemic in the subcontinent will spell the death knell of a cheap and effective drug in our armamentarium. Therefore it will be too premature to declare that the concept of using ciprofloxacin in typhoid fever is dead!.

Cite this Research Publication : Revathy Girish, Anil Kumar, Sadia Khan, Kavitha R. Dinesh, Shamsul Karim "Revised Ciprofloxacin Breakpoints for Salmonella: Is it Time to Write an Obituary?", Journal Clinical Diagnostic Research, 2013

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