The patients were started on
third generation cephalosporin and metronidazole.
Conclusions:
Third generation Cephalosporin resistance is present in 16.2% of patients with community acquired spontaneous bacterial peritonitis.
A systematic review of the literature showed that tazobactam and clavulanic acid are partial inhibitors of KPCs and the hydrolysis of the
third generation cephalosporin is relatively weak in KPCs [5].
We report a case of typhoid due to Salmonella enteric serovar Typhi which was resistant to all the first line antibiotics as well as fluoroquinolones and
third generation cephalosporin. Hence the patient had to be treated with meropenem, a carbapenem drug which is not usually recommended for the treatment of typhoid fever.
Pneumoniae found resistant to any one of the
third generation cephalosporin should be suspected of being a potential ESBL producer and should be subjected to the double disc synergy test.The use of more than one discs increases the sensitivity of ESBL detection10.
The Infectious Diseases Society of America Clinical Practice Guidelines recommend for methicillin susceptible staph aureus (MSSA), streptococcus or enterobacteriaceae a second or
third generation cephalosporin, quinolone, or carbapenem.
Ceftizoxime is
third generation cephalosporin effective against aerobic gram positive bacteria, gram negative bacilli and anaerobic bacteria.
aeruginosa and the combination of vancomycin and
third generation cephalosporin might not be effective in number cases of bacterial endophthalmitis.
The patient went to the emergency department immediately and was admitted to the intensive care unit where he received intravenous treatment with
third generation cephalosporin (1 g ceftriaxone) and an intramuscular aminoglycoside (800 mg isepamicin).
In our study, resistance to
third generation cephalosporin's was found to coexist with resistance to two or more antibiotics like ampicillin, nalidixic acid, cotrimoxazole, nitrofurantoin, norfloxacin, amikacin as also reported by Subha et al (18) and Duttaroy et al (19) indicating multidrug resistance pattern.