Treatment Response and Fever clearance time of Typhoid Patients in a North Indian Tertiary Care Setting

Background: Typhoid fever, caused by Salmonella Typhi and Paratyphi, remains a significant public health issue in India. This study assessed the clinical and microbiological profile of Salmonella bacteremia and examined the association of fever clearance time (FCT) with antibiotic regimens. Material and Methods: This prospective study was conducted at Christian Medical College and Hospital, Ludhiana, over one year (November 2016–October 2017). Patients ≥12 years of age with blood culture–proven Salmonella infection were enrolled. Clinical details, prior antibiotic exposure, laboratory results, and FCT were documented. Blood cultures were processed using BD Bactec, and MICs were determined as per CLSI guidelines. Repeat cultures on day 7 assessed microbiological cure. Results: Fifty patients were studied; 38 (76%) had S. Typhi and 12 (24%) had S. Paratyphi A. The mean age was 28.4±10.1 years, and 64% were males. Headache (60%) and abdominal pain (46%) were common presentations. Prior antibiotic use was noted in 24%, most frequently cefixime. Among S. Typhi patients, mean FCT was 64.07±13.36 hours with monotherapy and 67.4±19.87 hours with combination therapy (p=0.557). In S. Paratyphi A, mean FCT was 63.64±12.71 hours with single therapy and 84 hours with combination therapy (p=0.156). Hospital stay duration was comparable across both S. Typhi and S. Paratyphi (median 7 days each, p=0.878). Conclusion: To conclude, S. Typhi predominated over S. Paratyphi A. Both single and dual therapies were effective, with no significant differences in FCT or hospitalisation, emphasising rational antibiotic use in endemic settings.

Keywords: bacteremia, blood culture, cefixime, Salmonella infections, Salmonella typhi, typhoid fever.