Abstract
Typhoid fever is a major burden on our healthcare system. There were times when typhoid responded to many antibiotics. With the passage of time, however, the causative agent of typhoid fever, Salmonella Typhi (S. Typhi), has developed resistance to many antibiotics, creating multi-drug resistant (MDR) strains. MDR strains do not respond to traditional first-line antibiotic drugs such as chloramphenicol, ampicillin, amoxicillin and trimethoprim-sulfamethoxazole and have also developed sporadic resistance to some secondline drugs, such as fluoroquinolones, especially in Asian and African countries. An extensively drugresistant (XDR) S. Typhi strain has emerged in Pakistan which is resistant to all routinely recommended antibiotics for typhoid fever, including first-line and second-line drugs as well as third-generation cephalosporins1,2 . An outbreak of extensively drug resistant (XDR) typhoid fever began in the Hyderabad district of Sindh province which created havoc in November 2016. Following a review by an expert group of epidemiologists, clinicians and microbiologists from Pakistan, the “Regional Disease Surveillance and Response Unit” (RDSRU) in Karachi presented case definitions for non-resistant, multidrug resistant (MDR) and XDR typhoid fever in May 2018. These were formally agreed by the “XDR National Taskforce” (established in July 2018) and a joint WHO and Centers for Disease Control and Prevention (CDC) USA mission. World health organization (WHO) published disease outbreak news of XDR typhoid in Pakistan on December 27, 20183 .
