New resistance mechanisms among antibiotics are spreading worldwide. They are affecting the treatment of common infectious diseases, resulting in adverse clinical outcomes, death and huge consumption of healthcare resources.

Typhoid fever, an endemic disease in India, is a multisystem febrile disease caused primarily by Salmonella　enterica serovar Typhi (S. Typhi). Ceftriaxone resistance has not been very prevalent in India [1], and it continues to be the first choice of drug for the inpatient management of typhoid. However, resistance to ceftriaxone and fluoroquinolone is increasingly being reported in Salmonella enterica subspecies from Asia and Africa [2]. During January to June 2019, 19 clinical isolates of Salmonella Typhi　were isolated from 3696 blood culture specimens, collected from children admitted at Bai Jerbai Wadia Hospital for Children, Mumbai, India. Resistance to ceftriaxone was seen in 14 (73.7%) isolates, while 10 (52.6%) were resistant to fluroquinolones. No resistance was reported towards aztreonam, ceftazidime, colistin, cefepime, doripenem, imipenem, meropenem, cotrimoxazole, cefoperazone/sulbactum, ticarcillin/ clavulinic acid and tigecycline.

Penicillin was the standard drug of choice for treating pneumococcal infections for many years until the emergence of resistance to penicillin [3], which compelled the use of alternative antibiotics. Among the 20 microbiologically identified pneumococcal isolates in pediatric patients from our laboratory, cefotaxime and ceftriaxone non-susceptible pneumococci accounted for 5 (25%) cases. Some of these cases also showed levofloxacin resistance (37.5%). Thus, it can be implied that the overall prevalence of resistance to beta-lactam agents amongst pneumococcal species mirrors the rise in resistance documented worldwide [4].

Staphylococcus aureus is an important cause of both community-acquired as well as hospital-associated infections. The incidence of methicillin resistant S. aureus (MRSA) varies from 25 per cent in Western part of India to 50 per cent in Southern India [5]. In 175 confirmed cases of infections due to Staphylococcus aureus, prevalence of MRSA was 133 (76%). No resistance was reported towards vancomycin, teicoplanin, linezolid and tigecycline. b-lactams are superior for the treatment of MSSA bacteremia and endocarditis. With MRSA isolates being widespread, it is necessary to de-escalate to b-lactams once the cultures reveal a MSSA isolate. Glycopeptides and linezolid need to be used only against MRSA isolates.

In conclusion, high level of resistance to the first line drugs probably reflects their overuse or irrational use in the treatment of unrelated infections. This calls for more studies and mandates a review of first line therapeutic strategies.