A Systematic Review of Antibiotic Resistance in Nontyphoidal Salmonella in South Asia (1997-2012) Público
Humphries Jr., Kevin Wayne (2012)
Abstract
Introduction: Nontyphoidal Salmonellosis (NTS) is a problem for the region of South Asia which is home to half the world's poor and contains the greatest number of malnourished children. Antibiotic resistance has made the disease burden caused by NTS more difficult to mitigate since many common NTS strains are no longer susceptible to a wide range of antibiotics.
Project Goal: This systematic review was conducted to understand the level of effectiveness of antibiotics against NTS strains in South Asia with a focus on the effectiveness of the WHO recommended antibiotic therapy: Floroquinolones and third generation cephalosporins followed by either ampicillin, amoxicillin, co-trimoxazole, or chloramphenicol if necessary.
Methods: A systematic review of literature of all human related Salmonella isolates from 1997-2012 was conducted using PubMed after the titles and abstracts were screened for material concerning antimicrobial resistance tests to antibiotics.
Results: Fifty-one percent of isolates (n=252) tested for nalidixic acid susceptibility were resistant and 31% (n=184) for ciprofloxacin. The other floroquinolones tested for NTS susceptibility in the studies under review were enrofloxacin, norfloxacin, and sparfloxacin (Table 2) and Salmonella pathogens showed resistance rates of 3% (n=2), 5% (n=7), and 6% (n=1) respectively. The third generation cephalosporins tested for NTS drug resistance yielded an average resistance of 37% (n=10) for cefpodoxime, 34% (n=37) for cefoperazone, 30% for cefotaxime (n=61), 18% (n=28) for ceftazidime, and 16% (n=53) for ceftriaxone. However, there was a wide range of variation among the studies. Among first line drugs chloramphenicol, NTS pathogens had the lowest amount of resistance to chloramphenicol 12% (n=70) compared to 38% (n=127) of amoxicillin, 38% (n=237) of ampicillin, and 32% of co-trimoxazole (n=110). The reviewed literature includes resistant isolates from vegetables, seafood, meat, eggs, humans, and even environmental water sources.
Conclusion: Resistant serovars were isolated from a wide variety of sources showing the need for stricter management of antibiotics for medical purposes and agricultural purposes to mitigate the NTS burden of disease; protect immunocompromised populations such as malnourished children, the elderly, and those living with HIV/AIDS; and to lift the economic burden caused by NTS.
Table of Contents
Background...1
Literature Review...3-7
Methods...6-9
Table 1: Results of PubMed Database search and screenings...7
Results...8-9
Discussion...9-11
References...12-14
Appendix...15-27
Table 2: Antimicrobial resistance of
Nontyphoidal Salmonella isolates against antimicrobial therapy
drugs recommended by WHO...15-17
Table 3: NTS Resistance against all antibiotics used in studies of
systematic review...18
Table 4: Complete Resistance by Percentage against Drugs
Azithromycin - Doxycycline...19-22
Table 5: Complete Resistance by Percentage against Drugs
Enrofloxacin - Trimethoprim...23-27
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