50 Years Ago in The Journal of Pediatrics: Drug Sensitivity to Salmonella typhi: Coming Full Circle

In 1970, Chawla et al were concerned about the “rampant use” of chloramphenicol for treatment of typhoid fever owing to its serious toxic effects. They studied hetacillin (a synthetic derivative of 6-aminopenicillinic acid) as a safer alternative and concluded that it had comparable efficacy with fewer side effects.

Fifty years later, typhoid fever remains a public health problem, especially in developing countries, causing approximately 11 to 21 million cases and 128 000 to 161 000 deaths annually, with the peak incidence in children aged 5 to <15 years. Up to the 1970s, chloramphenicol was widely used to treat enteric fever. It was replaced by ampicillin and trimethoprim-sulfamethoxazole due to the emergence of resistant strains. In the early 1980s, there was a rapid emergence of IncHI1 plasmid-mediated resistance to all 3 drugs, in multidrug-resistant strains. This prompted the use of fluoroquinolones, which were highly efficacious.