IMPACT OF ANTIMICROBIAL RESISTANCE ON THE TREATMENT OF TYPHOID FEVER IN SELECTED PRIMARY HEALTH CARE CENTERS IN ABUJA

Abstract

Typhoid fever remains a major public health concern in Nigeria, with antimicrobial resistance (AMR) complicating treatment, especially in primary health care (PHC) settings. This study assessed the impact of AMR on typhoid fever management in selected PHCs in Abuja, focusing on resistance patterns, treatment outcomes, and associated factors. A hospital-based cross-sectional study was conducted from March to August 2025 in three PHCs (Garki, Nyanya, and Wuse). Using systematic random sampling, 422 patients with suspected typhoid fever were enrolled. Blood cultures confirmed Salmonella Typhi infections, and antimicrobial susceptibility was tested via Kirby-Bauer disk diffusion per CLSI guidelines. Data on demographics, resistance profiles, and outcomes (success, failure, relapse) were analyzed using SPSS, with chi-square tests and logistic regression (p<0.05 significant). S. Typhi was isolated in 276 (65.4%) cases. Resistance rates were high for ampicillin (72.5%), chloramphenicol (68.1%), cotrimoxazole (64.5%), and ciprofloxacin (58.0%), with moderate levels for ceftriaxone (33.0%) and azithromycin (28.6%). Treatment success occurred in 192 (69.6%) patients, failure in 54 (19.6%), and relapse in 30 (10.9%). Ciprofloxacin resistance (OR=3.8, 95% CI: 2.1–6.7, p=0.001) and ceftriaxone resistance (OR=2.5, 95% CI: 1.3–4.8, p=0.007) were significant predictors of failure. AMR substantially undermines typhoid fever treatment efficacy in Abuja's PHCs, driving failures and relapses. Urgent implementation of susceptibility testing, updated guidelines, and stewardship programs is recommended to mitigate this threat.