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dc.contributor.authorChristopher M. Parryen_US
dc.contributor.authorNga Tran Vu Thieuen_US
dc.contributor.authorChristiane Doleceken_US
dc.contributor.authorAbhilasha Karkeyen_US
dc.contributor.authorRuchi Guptaen_US
dc.contributor.authorPaul Turneren_US
dc.contributor.authorDavid Danceen_US
dc.contributor.authorRapeephan R. Maudeen_US
dc.contributor.authorVinh Haen_US
dc.contributor.authorChinh Nguyen Tranen_US
dc.contributor.authorPhuong Le Thien_US
dc.contributor.authorBay Pham Van Been_US
dc.contributor.authorLa Tran Thi Phien_US
dc.contributor.authorRang Nguyen Ngocen_US
dc.contributor.authorAniruddha Ghoseen_US
dc.contributor.authorSabina Dongolen_US
dc.contributor.authorJames I. Campbellen_US
dc.contributor.authorDuy Pham Thanhen_US
dc.contributor.authorTuyen Ha Thanhen_US
dc.contributor.authorCatrin E. Mooreen_US
dc.contributor.authorSoeng Sonaen_US
dc.contributor.authorRajni Gainden_US
dc.contributor.authorMonorama Deben_US
dc.contributor.authorHo Van Anhen_US
dc.contributor.authorSach Nguyen Vanen_US
dc.contributor.authorHien Tran Tinhen_US
dc.contributor.authorNicholas P.J. Dayen_US
dc.contributor.authorArjen Dondorpen_US
dc.contributor.authorGuy Thwaitesen_US
dc.contributor.authorMohamed Abul Faizen_US
dc.contributor.authorRattanaphone Phetsouvanhen_US
dc.contributor.authorPaul Newtonen_US
dc.contributor.authorBuddha Basnyaten_US
dc.contributor.authorJeremy J. Farraren_US
dc.contributor.authorStephen Bakeraen_US
dc.contributor.otherUniversity of Oxforden_US
dc.contributor.otherLiverpool School of Tropical Medicineen_US
dc.contributor.otherOxford University Clinical Research Uniten_US
dc.contributor.otherVardhman Mahavir Medical College & Safdarjung Hospitalen_US
dc.contributor.otherAngkor Hospital for Childrenen_US
dc.contributor.otherShoklo Malaria Research Uniten_US
dc.contributor.otherMahosot Hospitalen_US
dc.contributor.otherMahidol Universityen_US
dc.contributor.otherDong Thap Provincial Hospitalen_US
dc.contributor.otherAn Giang Provincial Hospitalen_US
dc.contributor.otherChittagong Medical College Hospitalen_US
dc.contributor.otherCentre for Specialized Care and Researchen_US
dc.contributor.otherLondon School of Hygiene & Tropical Medicineen_US
dc.contributor.otherNagasaki Universityen_US
dc.identifier.citationAntimicrobial Agents and Chemotherapy. Vol.59, No.5 (2015), 2756-2764en_US
dc.description.abstractCopyright © 2015, Parry et al. Azithromycin is an effective treatment for uncomplicated infections with Salmonella enterica serovar Typhi and serovar Paratyphi A (enteric fever), but there are no clinically validated MIC and disk zone size interpretative guidelines. We studied individual patient data from three randomized controlled trials (RCTs) of antimicrobial treatment in enteric fever in Vietnam, with azithromycin used in one treatment arm, to determine the relationship between azithromycin treatment response and the azithromycin MIC of the infecting isolate. We additionally compared the azithromycin MIC and the disk susceptibility zone sizes of 1,640 S. Typhi and S. Paratyphi A clinical isolates collected from seven Asian countries. In the RCTs, 214 patients who were treated with azithromycin at a dose of 10 to 20 mg/ml for 5 to 7 days were analyzed. Treatment was successful in 195 of 214 (91%) patients, with no significant difference in response (cure rate, fever clearance time) with MICs ranging from 4 to 16 μg/ml. The proportion of Asian enteric fever isolates with an MIC of ≤16 μg/ml was 1,452/1,460 (99.5%; 95% confidence interval [CI], 98.9 to 99.7) for S. Typhi and 207/240 (86.3%; 95% CI, 81.2 to 90.3) (P < 0.001) for S. Paratyphi A. A zone size of ≥13 mm to a 5-μg azithromycin disk identified S. Typhi isolates with an MIC of ≤16 μg/ml with a sensitivity of 99.7%. An azithromycin MIC of ≤16 μg/ml or disk inhibition zone size of ≥13 mm enabled the detection of susceptible S. Typhi isolates that respond to azithromycin treatment. Further work is needed to define the response to treatment in S. Typhi isolates with an azithromycin MIC of >16 μg/ml and to determine MIC and disk breakpoints for S. Paratyphi A.en_US
dc.rightsMahidol Universityen_US
dc.titleClinically and microbiologically derived azithromycin susceptibility breakpoints for Salmonella enterica serovars Typhi and Paratyphi Aen_US
Appears in Collections:Scopus 2011-2015

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