PESHAWAR: Paediatricians have expressed serious concerns over ineffectiveness of antibiotics in typhoid fever in children, urging health department to launch vaccination campaign, improve water and sanitation services and ensure rational use of antibiotics.
The authors of a recently published study have written to health department that the findings have confirmed extensively drug-resistant (XDR) typhoid in Khyber Pakhtunkhwa, severely limiting treatment options.
The study titled “Emerging trends of antimicrobial resistance in salmonella Typhi and Paratyphi A: A three-year surveillance report from Khyber Pakhtunkhwa, Pakistan,” has been recently published in Medtigo Journal Network.
The authors of the study include Dr Kashifullah, Dr Bilal Noor, Dr Mohammad Suliman, Dr Hamid Iqbal Bangash, Rehman Gul, Dr Khadija Aziz and Dr Ziadullah Shah.
Study urges govt to take preventive measures to safeguard children
According to the letter titled “Alarming situation of drugs resistant enteric fever (salmonella Typhi) cases in Khyber Pakhtunkhwa” the lead author has drawn the attention of health secretary and director-general health services to increase in drug resistant enteric fever cases in the province.
The authors of the study said that they were consistently receiving patients with fever unresponsive to routine treatment. They said after investigation, such patients were diagnosed with culture positive drug resistant salmonella Typhi.
“To ascertain the severity of the matter, we obtained data from a well-reputed Lahore-based laboratory which revealed 621 positive cases, including 562 salmonella Typhi and 59 Paratyphi,” they said. Regarding the resistance patterns, they have named resistant drugs used by those patients.
The study, conducted by paediatricians working in Naseerullah Khan Babar Memorial Hospital Peshawar, said that resistant level to Ciprofloxacin was 100 per cent, Ampicillin 95pc, Cefixime 92pc, Ceftriaxone 92pc, Chloramphenicol 90pc and Trimethoprim-Sulfamethoxazole 81pc.
It said only two antibiotics including Azithromycin and Meropenem were found fully effective. According to it, Azithromycin remains the only effective oral option, but its irrational prescribing may drive resistance like other antibiotics.
“Meropenem is fully effective, but its inappropriate use risks resistance development as well,” said the authors of the study. Beset by the situation with which the antibiotics are used, they have asked health department to take preventive measures to safeguard children.
The recommendations of the study said that the department should launch mass vaccination campaigns using typhoid conjugate vaccine (TCV) in addition to strengthening water, sanitation and hygiene infrastructure in the province.
A public awareness drive is important on the significance of safe water and hand hygiene, clean filter water, hygiene practices, child safety, health awareness sessions and establishing linkages among hospitals to ensure proper referral system of patients. The government should check unhygienic conditions in kitchens in hotel, street vendors, poor quality ice factories and sanitation system.
Health experts have also called upon government to put in place rational antibiotic policy, including restriction on the use of Meropenem and Azithromycin as first-line treatment by general practitioners and reserve use of Meropenem strictly for hospitalised and culture-proven severe cases.
“Implement strong antibiotic stewardship programmes in healthcare facilities with surveillance and reporting system,” they said. They added that the department should conduct regular antimicrobial resistance (AMR) monitoring across the province with establishment of a central, real-time AMR database for policy guidance.
They said that hospital protocols should be developed with strict directive that typhoid cases should be treated only after blood culture confirmation where possible and avoidance empirical overuse of Carbapenems to prevent further spread of drug-resistant typhoid in Khyber Pakhtunkhwa.
Published in Dawn, November 19th, 2025.
