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Is nalidixic acid resistance linked to clinical virulence in Salmonella enterica serovar Typhi infections?

Fluoroquinolones are the drugs of choice for the treatment of typhoid fever caused by multidrug-resistant Salmonella enterica serovar Typhi (MDR-ST) infections. Decreased susceptibility of S. Typhi isolates to fluoroquinolones is emerging as an important problem in South Asian countries such as India, Vietnam, and elsewhere (Parry, 2004; Rahman et al., 2006; Renuka et al., 2005). Nalidixic acid resistance is useful as a surrogate marker of decreased susceptibility to fluoroquinolones (Hakanen et al., 1999). We have previously reported the association of nalidixic acid-resistant S. Typhi (NARST) infection with prolonged duration of illness at presentation, increased clinical severity of illness and complications (Kadhiravan et al., 2005). Here, we present the results of the exploratory analysis of the data regarding the association of drug resistance with fever clearance time.