There is only one antibiotic left, and if it becomes resistant, a major crisis is on the way.

Antibiotic resistance is steadily increasing due to unnecessary drug use. Typhoid, a long-time threat to humanity, may no longer be widely discussed, but it could once again pose a global threat due to antibiotic resistance.

Typhoid, a centuries-old threat to humanity, is no longer a popular topic in the modern world, but it remains a serious global threat. A published study has revealed that Salmonella enterica serovar Typhi (S Typhi), the bacterium that causes typhoid, is rapidly developing antibiotic resistance, and resistant strains are spreading rapidly.

Currently, the only effective treatment for typhoid is antibiotics. However, over the past 30 years, S Typhi bacteria have become increasingly resistant to oral antibiotics. According to a report in Science Alert, researchers conducted a genetic analysis of 3,489 typhoid bacteria samples obtained from Nepal, Bangladesh, Pakistan, and India between 2014 and 2019. The results showed that "extensively drug-resistant" (XDR) strains are spreading rapidly.

These XDR Typhi strains are completely resistant to key antibiotics such as ampicillin, chloramphenicol, and trimethoprim/sulfamethoxazole. Furthermore, resistance is developing to newer antibiotics such as fluoroquinolones and third-generation cephalosporins.

Even more worryingly, these resistant strains aren't limited to South Asia. Nearly 200 cases of international spread have been recorded since 1990. These superbugs have reached Southeast Asia, East and Southern Africa, and even the UK, US, and Canada.

"The rapid emergence and spread of highly resistant strains of S Typhi in recent years is a serious concern," said Jason Andrews, an infectious disease specialist at Stanford University, emphasizing the urgent need to increase prevention efforts.

The first XDR typhoid strain was identified in Pakistan in 2016. By 2019, it had become the dominant genotype in the country. Initially controlled with third-generation antibiotics, these strains gradually became resistant to these drugs. By the early 2000s, more than 85 percent of cases in Bangladesh, India, Pakistan, Nepal, and Singapore were resistant to fluoroquinolones.

If azithromycin becomes resistant, a crisis is looming.

Today, only one oral antibiotic remains: azithromycin. However, research indicates that mutations that cause azithromycin resistance are also spreading rapidly. While these mutations have not yet been linked to XDR Typhi, if they do occur, it could pose a major health crisis.

If left untreated, typhoid fever can have a mortality rate of up to 20 percent. Approximately 11 million cases of typhoid occur each year. Typhoid conjugate vaccines offer an important preventative measure. However, if global access to the vaccine is not achieved, a new epidemic could be imminent.

'MEASURES MUST BE SPREAD ON A GLOBAL SCALE'

Researchers emphasize that vaccination should be rapidly expanded, especially in high-risk regions such as South Asia, and that measures should not be limited to these regions due to the risk of international spread.

Pakistan is cited as the first country to introduce routine typhoid vaccination. Scientists say more countries should adopt this policy, as antibiotic resistance has become a global killer, claiming more lives than HIV/AIDS and malaria combined.