Trends in antibiotic resistance amongst pathogens causing enteric fever in India, Nepal and Pakistan 2012-2021

Abstract: Background: Incidence of enteric fever, caused by Salmonella typhi and Salmonella paratyphi, is estimated between 12 million to 27 million cases. Peak incidence rates occur in children younger than 15 years of age and the disease have a case fatality rate of 1%. Rise in antimicrobial resistance is a concerning world-wide phenomena and the first reports of resistant S.typhi occurred in the 1950s. Over the years, resistance against various antibiotics have increased, especially in endemic countries such as Bangladesh, India, Nepal and Pakistan. Aim: The aim of this study is to describe antibiotic resistance developed in endemic areas in Nepal, India and Pakistan over a 10-year period, 2012-2021. Methods: This is a systematic literature review where the database PubMed has been used. The study was structured by using PRISMA statement guidelines. A search plan was based on inclusion criteria and search words using PICOS format. In addition, eight exclusion criteria were applied in the selection of articles. Two searches were made, the first on November 16th, 2023 and the second on November 22nd, 2023. Risk of bias was evaluated by using the MINORS criteria. Results: A total of nine articles were included in the study, by filtering the articles based on inclusion and exclusion criteria. From these articles, data regarding resistance against nine different antibiotic agents and bacteria presenting with multi-drug resistance. Trends of rising resistance was seen against cefixime, ceftriaxone and trimethoprim/sulfamethoxazole. Agents showing both increasing and decreasing resistance include ampicillin, ciprofloxacin and chloramphenicol. Conclusion: This study concludes that antibiotic resistance among pathogens causing enteric fever, i.e. S. typhi and S. paratyphi, is a rising concern. Further studies are needed to follow the situation and to enable the necessary measures to be taken.