ABSTRACT
Background: Infant mortality rate due to diarrhea is high in Pakistan. The alarming increase in antimicrobial resistance of bacterial pathogens causing diarrhea has made the treatment more complicated. This study was designed to determine the in vitro synergistic [combined] effect of different antibiotics against these pathogens in order to determine whether the combined antibiotic therapy may be used to treat diarrhea
Objectives: To study the antibiotic resistance pattern of bacterial pathogens causing diarrhea isolated from children <5 years. To study the synergistic effect of antibiotics against bacterial pathogens causing diarrhea. Study design, settings and duration: A cross sectional study conducted at Pakistan Health Research Council [PHRC], Jinnah Postgraduate Medical Center and National Institute of Child Health, Karachi over a period of twenty months
Materials and Methods: Bacterial pathogens including Salmonella, Shigella, Vibrio, Escherichia coli and Aeromonas causing diarrhea were collected. Their sensitivity and resistance pattern was performed by disk diffusion method and combined the effect of existing antibiotics including ampicillin [AMP], cefotaxime [CTX], Cefixime [CFM], Co-trimoxazole [SXT] and Ofloxacin [OFX] was performed by checkerboard method. The study was approved by Ethical Review Board of National Institute of Child Health, Karachi
Results: Most of the combinations showed indifferent and antagonistic activity against bacterial pathogens causing diarrhea. But only AMP-SXT and CFM-OFX yielded synergistic activity against Vibrio and Aeromonas respectively. AMP-CFM and AMP-OFX exhibit synergistic effect against Escherichia coli while no combination of antibiotics proved as synergistic for Salmonella and Shigella
Conclusion: Little synergistic activity of different antibiotic combinations was observed against diarrheal isolates and most of the combinations exhibited indifferent and antagonistic activity. Hence this can be concluded that single antibiotics are effective than combination