Public Health Implications of XDR Typhoid Spread in Pakistan and Roadmap for Resistance Mitigation

Due to the advent of XDR <i>Salmonella </i>Typhi, antibiotic resistance in typhoid fever presents a serious public health concern, leading to treatment failure and extended illness. Of all the serotypes of <i>Salmonella </i><i>enterica</i><i>, </i>serovar Typhi is the most prevalent serotypes and is capable of developing resistance. A worrying trend is the appearance of extensively drug resistant (XDR) <i>S. </i>Typhi in many parts of the world, especially Pakistan. However, a thorough understanding of the epidemics and the creation of immediate responses are hampered by the lack of data. An updated summary of the current XDR <i>Salmonella</i> Typhi outbreaks in endemic and epidemic areas is being described due to reports of treatment failure in both humans and animals, treating XDR <i>Salmonella </i>Typhi infections is difficult. However, strict preventative measures can be put in place until the discovery of novel and alternative treatment options. Quick surveillance of pathogenic micro-organisms and an emphasis on antimicrobial stewardship are necessary to monitor potential spread of the epidemics in human and animal populations alike. Despite the fact that certain areas are making headway against XDR<i> Salmonella</i> Typhi, a concerted and effective global effort is needed to stop the XDR outbreak before it worsens and sends us back to the era before antibiotics.