PESHAWAR: Patients suspected of having typhoid fever continue to undergo Widal and Typhidot tests at hospitals and private clinics for confirmation of the disease despite ban on these investigations by government, according to sources.

Senior physicians call for an end to these tests and recommend blood culture test to confirm typhoid and avoid complications.

Khyber Pakhtunkhwa Health Care Commission issued directives in 2022 that Widal and Typhidot tests should be discontinued and only blood culture should be conducted for confirmation of extensively drug-resistant (XDR) typhoid as per guidelines of National Institute of Health (NIH), Islamabad. However, laboratories continue to receive samples from patients for these tests.

Prof Syed Amjad Taqweem, the chief executive of Health Net Hospital Hayatabad, told Dawn that blood culture was the only way to confirm typhoid. “Widal and Typhidot are useless and should not be conducted at all,” he added.

Medics recommend blood culture to confirm the ailment and avoid complications

According to him, he has been seeing positive Widal tests of patients that cannot be taken as confirmed cases as every typhoid patient requires blood culture. Misuse of antibiotics is cause of the disease while proper use as per culture and sensitivity is its prevention.

“Don’t ever use Azithromycin and Meronem unnecessarily without conducting culture,” said Prof Amjad. He said that almost everyone had XDR in Hayatabad and on top of it now resistance to Azithromycin too.

He said that only effective medicine like Meronem should be coupled with Azithromycin and given in proper dose to patient under the care of consultant. “These medicines should not be used by general practitioners and resistant cases should be referred to consultants to avoid resistance to these also. Any negligence by general practitioners can be catastrophic for community,” he added.

Prof Khalid Mahmood at Peshawar General Hospital said that typhoid fever was common in low income countries like Pakistan that was caused by bacteria called salmonella.

“Once you have the disease, prescription of antibiotics according to culture and sensitivity and for sufficient duration is necessary to treat the index cases and prevent its spread,” he said.

Prof Khalid said that it had become a major public health problem due to the emergence of the resistance. “Lately extensively drug-resistant strains of salmonella are increasing rapidly in Pakistan after the initial reported cases from Sindh few years ago,” he added.

He said that every second patient with typhoid fever was having XDR salmonella. He said that those newly emerging strains were resistant to most of the antibiotics including Flouroquinolone and third generation Cephalosporin. These bugs are sensitive to Carbapenem and Azithromcin mostly.

Carbapenm antibiotics are very expensive and beyond the reach of many patients. This has led to increase in cases of complicated typhoid fever with resultant increase in mortality.

In order to counter this menace, meticulous attention should be paid to personal hygiene and food and water sanitation. Typhoid Conjugate Vaccine is also available and is very effective in preventing the disease.

“We are receiving patients from all over the province as there is outbreak. We need massive vaccination campaign, use of clean drinking water, washing hands and avoidance of excessive use of antibiotics to prevent the disease,” he said.

Prof Khalid, a former physician at Lady Reading Hospital Peshawar, said that antibiotics were usually given for typhoid fever diagnosed on the basis of positive Widal or Typhidot tests that were obsolete and not advisable to diagnose the ailment.

“It is strongly recommended to use antibiotics for bacterial infections only and after culture tests,” he said. He said that simple first generation antibiotics should be preferred and certain potent and injectable antibiotics should only be used in hospital settings and on the basis of positive culture report.

“If we continue to misuse antibiotics many more resistant bugs are likely to come up in future and simple surgical procedures would end up in post-operative surgical site infections, leading to increase in morbidity and mortality,” said Prof Khalid.

Published in Dawn, April 8th, 2024