Publication:
Clinically and microbiologically derived azithromycin susceptibility breakpoints for Salmonella enterica serovars Typhi and Paratyphi A

2

Issued Date

2015-05-01

Resource Type

Article

ISSN

10986596
00664804

DOI

10.1128/AAC.04729-14

Other identifier(s)

2-s2.0-84931272449

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

Antimicrobial Agents and Chemotherapy. Vol.59, No.5 (2015), 2756-2764

Suggested Citation

Christopher M. Parry, Nga Tran Vu Thieu, Christiane Dolecek, Abhilasha Karkey, Ruchi Gupta, Paul Turner, David Dance, Rapeephan R. Maude, Vinh Ha, Chinh Nguyen Tran, Phuong Le Thi, Bay Pham Van Be, La Tran Thi Phi, Rang Nguyen Ngoc, Aniruddha Ghose, Sabina Dongol, James I. Campbell, Duy Pham Thanh, Tuyen Ha Thanh, Catrin E. Moore, Soeng Sona, Rajni Gaind, Monorama Deb, Ho Van Anh, Sach Nguyen Van, Hien Tran Tinh, Nicholas P.J. Day, Arjen Dondorp, Guy Thwaites, Mohamed Abul Faiz, Rattanaphone Phetsouvanh, Paul Newton, Buddha Basnyat, Jeremy J. Farrar, Stephen Bakera Clinically and microbiologically derived azithromycin susceptibility breakpoints for Salmonella enterica serovars Typhi and Paratyphi A. Antimicrobial Agents and Chemotherapy. Vol.59, No.5 (2015), 2756-2764. doi:10.1128/AAC.04729-14 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/36461

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Title

Clinically and microbiologically derived azithromycin susceptibility breakpoints for Salmonella enterica serovars Typhi and Paratyphi A

Author(s)

Christopher M. Parry
 Nga Tran Vu Thieu
 Christiane Dolecek
 Abhilasha Karkey
 Ruchi Gupta
 Paul Turner
 David Dance
 Rapeephan R. Maude
 Vinh Ha
 Chinh Nguyen Tran
 Phuong Le Thi
 Bay Pham Van Be
 La Tran Thi Phi
 Rang Nguyen Ngoc
 Aniruddha Ghose
 Sabina Dongol
 James I. Campbell
 Duy Pham Thanh
 Tuyen Ha Thanh
 Catrin E. Moore
 Soeng Sona
 Rajni Gaind
 Monorama Deb
 Ho Van Anh
 Sach Nguyen Van
 Hien Tran Tinh
 Nicholas P.J. Day
 Arjen Dondorp
 Guy Thwaites
 Mohamed Abul Faiz
 Rattanaphone Phetsouvanh
 Paul Newton
 Buddha Basnyat
 Jeremy J. Farrar
 Stephen Bakera

Other Contributor(s)

UCL
 University of Oxford
 Liverpool School of Tropical Medicine
 Oxford University Clinical Research Unit
 Vardhman Mahavir Medical College & Safdarjung Hospital
 Angkor Hospital for Children
 Shoklo Malaria Research Unit
 Mahosot Hospital
 Mahidol University
 Dong Thap Provincial Hospital
 An Giang Provincial Hospital
 Chittagong Medical College Hospital
 Centre for Specialized Care and Research
 London School of Hygiene & Tropical Medicine
 Nagasaki University

Abstract

Copyright © 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.

Keyword(s)

Medicine

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URI

https://repository.li.mahidol.ac.th/handle/123456789/36461

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Scopus 2011-2015