KARACHI: Amid worsening Covid-19 situation, cases of extensively drug resistant (XDR) typhoid have raised concerns among health professionals who have called upon the general public to practice safe eating and drinking habits, vaccinate against the disease and, last but not least, avoid self-medication.

“While Covid-19 remains our major concern, we are also getting patients of dengue and XDR typhoid. At times, patients report with multiple health issues, making diagnosis and treatment challenging as symptoms of dengue, Covid-19 and XDR typhoid are largely similar,” said Dr Abdul Ghafoor Shoro, a senior family physician at the Aga Khan University Hospital (AKUH).

It’s important that a physician made the correct diagnosis and ruled the possibility of other diseases before focusing on Covid-19, he added.

Explaining how drug resistance may develop in this particular health situation, he said Covid-19 fears and misinformation on social media had increased the trend of self-medication among the general public as many people avoided visiting hospitals or laboratories on doctor’s advice these days.

Doctors stress the need for correct diagnosis as symptoms of dengue, Covid-19 and XDR typhoid are largely similar

“There is an antibiotic drug called azithromycin, the only oral medicine we have so far to treat XDR typhoid. Now, this medicine is also being given to secondary Covid-19 patients (who develop pneumonia). We fear that Covid-19 patients with mild illness may use it without prescription and develop resistance against this medicine.

“Doctors should also exercise caution as any misuse of this medicine may lead to drug resistance,” he said, adding that since it’s an oral medicine it’s easy to be administered especially to children with typhoid unlike the other drug for XDR typhoid.

Given the spike in Covid-19 cases, it won’t be unrealistic to assume that substandard forms of this medicine would also be available in the market and their use might also cause drug resistance.

Seconding his opinion, senior physician Dr Altaf Khatri, who runs a private clinic in the old city area, said azithromycin was prescribed in different ailments and people must not use it without prescription and follow its recommended dose, if it’s prescribed.

“A majority of Covid-19 patients have either mild or no symptoms [and do not require this medicine]. Doctors should provide relief to patients after seeing the severity of their symptoms. They should guide patients and call them for a follow-up,” he said, underscoring the need for a holistic approach in treatment.

Vaccination drive reduces XDR typhoid cases

Asked about the numbers of XDR typhoid cases at the National Institute of Child Health, Dr Jamal Raza, director of the institute, said they had greatly reduced following the government’s vaccination drive.

“Before that drive, our wards were full with typhoid patients. I must say that the role of routine immunization is extremely important and parents need to fulfil their responsibility in this regard,” he said.

According to the WHO, typhoid fever is a life-threatening infection caused by the bacterium Salmonella Typhi. It is usually spread through contaminated food or water.

Symptoms include prolonged fever, fatigue, headache, nausea, abdominal pain, and constipation or diarrhoea. Some patients may have a rash. Severe cases may lead to serious complications or even death.

Typhoid fever can be treated with antibiotics although increasing resistance to different types of antibiotics is making treatment more complicated.

Published in Dawn, June 17th, 2020