Drug-resistant typhoid spreads in Pakistan as antibiotics fail raising global concern

In recent years, Pakistan has been grappling with an unprecedented public health challenge: the spread of drug-resistant typhoid. 

This has escalated from an isolated issue into a national crisis, particularly due to the emergence of extensively drug-resistant (XDR) strains. 

As the global community monitors this alarming situation, Pakistan finds itself at the epicentre of a battle between medical science and evolving bacterial resistance.

Typhoid fever, caused by the bacterium ‘Salmonella enterica’ serotype Typhi, is a waterborne illness that primarily spreads through the consumption of contaminated food or water. 

Common symptoms include prolonged fever, abdominal pain, and gastrointestinal issues. 

While typhoid has historically been treatable with antibiotics, the situation in Pakistan has worsened due to the rise of drug-resistant strains.

In 2016, cases of XDR typhoid were first identified in Hyderabad in south-eastern Sindh province. 

The XDR strain is resistant to five classes of antibiotics, including the commonly used first-line drugs like ampicillin and trimethoprim-sulfamethoxazole, as well as later-generation antibiotics such as fluoroquinolones and cephalosporins. 

This leaves doctors with limited treatment options, such as azithromycin or carbapenems, which are not only more expensive but also harder to access, particularly for low-income populations.

Since the initial detection, the XDR typhoid outbreak has rapidly spread throughout the country, with Sindh remaining the worst-affected region. 

Pakistan’s largest city, Karachi, has reported thousands of cases, making it the epicentre of the outbreak. 

Health officials said over 11,000 cases of XDR typhoid have been documented in Pakistan, though the actual number is likely higher due to underreporting and limited healthcare access in rural areas.

According to a report by The Guardian, the South Asian country has vaccinated more than 30 million children against typhoid since 2019, but these efforts have been mostly concentrated in the south of the country, where drug-resistant typhoid first emerged. 

There are more than 100 million children in Pakistan, and the infection has spread north, as per the Guardian report.

The outbreak has raised alarm internationally, with reports of drug-resistant typhoid cases in travellers returning from Pakistan to other countries, and this has turned what was once a local issue into a global public health concern.

According to an editorial by Pakistan’s leading English daily The Dawn, Pakistan has the worst rate of typhoid in South Asia, with the extensive XDR strain of ‘superbug’ as the combination of poor sanitation, contaminated water and the indiscriminate administration of antibiotics by medical practitioners has turned the disease into a formidable health threat for millions of Pakistanis, particularly children. 

The rise in XDR typhoid cases is posing a “particularly acute challenge to Pakistan’s feeble health infrastructure,” the editorial added.

There are several key factors contributing to the rapid spread of XDR typhoid in Pakistan.

Overuse and Misuse of Antibiotics: One of the most significant drivers of antibiotic resistance is the overuse and misuse of antibiotics. 

In the country, antibiotics are widely available over the counter, leading to their excessive and often inappropriate use. 

This has allowed bacteria like ‘Salmonella Typhi’ to evolve and resist commonly used treatments.

Poor Sanitation and Water Supply: Typhoid is typically spread through contaminated water and food, and Pakistan’s inadequate water supply and sanitation infrastructure have made it easy for the bacteria to thrive. 

In urban slums and rural areas, where access to clean water is scarce, the disease can spread rapidly.

Lack of Public Awareness: There is a general lack of awareness about antibiotic resistance and proper hygiene practices among the public. 

Many people, unaware of the risks, self-medicate with antibiotics, further contributing to resistance.

Population Density and Urbanization: High population density in cities like Karachi, combined with inadequate healthcare infrastructure, has exacerbated the spread of the disease. 

Migratory movements between rural and urban areas also play a role in the transmission of resistant strains.

The human cost of XDR typhoid is immense. Children are particularly vulnerable to the disease, and their prolonged illness can lead to severe complications, including intestinal perforation and death, if not treated effectively. 

The reliance on last-resort antibiotics has also increased the cost of treatment, putting a financial burden on both families and the public healthcare system.

Additionally, the economic implications of the XDR typhoid outbreak are significant. 

Pakistan’s healthcare system is already stretched thin, and the rise of drug-resistant infections further strains medical resources. 

Hospitals, particularly in affected areas, are seeing increased patient loads, longer hospital stays, and the need for more expensive medications—all of which divert resources from other healthcare priorities.

The South Asian nation, however, has taken several steps to address the growing threat of drug-resistant typhoid, but challenges remain. 

The rise of XDR typhoid in Pakistan is a stark reminder of the global challenge posed by antibiotic resistance. 

As drug-resistant infections continue to spread, they threaten to reverse decades of medical progress. 

Pakistan’s experience with XDR typhoid serves as a “case study” in the urgent need for coordinated global efforts to combat antimicrobial resistance (AMR).

International organizations like the World Health Organization (WHO) and the Centres for Disease Control and Prevention (CDC) have been monitoring the situation in Pakistan closely.  There is growing recognition that addressing drug-resistant typhoid in one country is essential for safeguarding global health, as infectious diseases do not respect national borders.