6 (2.1-8.5) 5.4 (1.0-16.8)    positive Widal test 16 (84) b 9 (16) c    ALT (> 40 IU/L) d 18 (72) 46 (74)    AST (> 45 IU/L) e 17 (68) 45 (73) Complications f 6 (24) 13 (21) a Data are presented as no. (%). b Only 19

patients were detected. c Only 55 patients were detected. d AST, aspartate transaminase (normal range, 0-40 IU/L). e ALT, alanine transaminase (normal range, 0-45 IU/L). f including toxic hepatitis, toxic myocarditis, intestinal hemorrhage, bronchitis, pneumonia, and bacterial meningitis. Table 5 Clinical treatments and outcomes in nalidixic acid-susceptible Salmonella (NASS) and nalidixic acid-resistant Salmonella Tipifarnib supplier (NARS)-infected patients treated with fluoroquinolones only a Antimicrobial agents   NASS-infected patients (n = 6) NARS-infected patients (n = 17)   Dosage Number Duration (d) Number Duration (d) LXH254 Ciprofloxacin 0.4 g IV q12h 5 7~13 8 7~21   0.2 g IV q12h 1 5 2 10~15 Levofloxacin

0.3 g IV q12h – - 1 7   0.2 g IV q12h – - 2 7~8 Gatifloxacin 0.2 g IV q12h – - 3 10~14   0.4 g IV q24h – - 1 13 a All of these 23 patients treated with fluoroquinolones only were cured. Discussion Nalidixic acid-resistant S. typhi and S. paratyphi are endemic in Vietnam and some

other South Asia countries such as India, Pakistan, Bangladesh, and Nepal [17], with a resistance rate range of 38-97%. It has been reported that more than 70% of Salmonella enteric serovar Typhimurium isolates are resistant to ciprofloxacin Nintedanib supplier and some have become multidrug-resistant in regions of China [4]. In this study, 52% of S. typhi and 95% of S. paratyphi A showed resistance to nalidixic acid, although they were still susceptible to ciprofloxacin according to the present CLSI breakpoints. Multidrug-resistant isolates were not detected among S. typhi and S. paratyphi A in our investigation. Interestingly, 90.7% of these nalidixic resistant-isolates carried the same gyrA mutation, leading to the substitution Ser83Phe, which was identical to that described in Vietnam in 2007 [18]. Importantly, the incidence of S. paratyphi A infection has surpassed that of S. typhi infection since 2003 in this study. The similar results had been reported in Guangxi Autonomous Region, China [19], reinforcing our results. A disproportionate increase in the incidence of enteric fever caused by S.