A new study has estimated that India recorded approximately 4.9 million cases of typhoid fever and 7,850 related deaths in 2023. Notably, Delhi, Maharashtra and Karnataka together accounted for nearly 29 per cent of the national disease burden, highlighting significant regional concentration.
Fluoroquinolone Resistance Drives Hospitalisations and Deaths
According to findings published in The Lancet Regional Health – Southeast Asia, fluoroquinolone resistance contributed substantially to severe outcomes. Of the estimated 7.3 lakh typhoid-related hospitalisations nationwide, nearly six lakh were linked to resistance against fluoroquinolones, a commonly used class of antibiotics. As a result, antimicrobial resistance emerged as a major driver of typhoid-related morbidity and mortality.
High-Burden States Show Highest Resistance Levels
Researchers found that Delhi, Maharashtra and Karnataka not only reported the highest number of typhoid cases but also recorded the highest rates of fluoroquinolone-resistant infections and related deaths among the ten highest-burden states. Consequently, these regions face a compounded challenge of high disease incidence and rising antibiotic resistance.
Understanding Typhoid Fever and Its Treatment
Typhoid fever is a bacterial infection that spreads through contaminated food and water. Symptoms typically appear one to three weeks after exposure and include high fever, headache, abdominal pain and fatigue. Treatment relies on antibiotics alongside supportive care; however, rising resistance threatens the effectiveness of commonly used drugs.
Long-Term Review Highlights Persistent Antibiotic Resistance
As reported by NDTV, the research team, which included scientists from the London School of Hygiene and Tropical Medicine and Christian Medical College, Vellore, reviewed studies published up to July 2025. Their analysis revealed persistently high fluoroquinolone resistance—exceeding 60 per cent over several decades, steadily increasing from 1989 and peaking at 94 per cent in 2017.
Encouraging Trends in Other Antibiotics
In contrast, resistance to third-generation cephalosporins and azithromycin—both widely used first-line treatments for typhoid—remained consistently low. Moreover, the study found that multidrug resistance has steadily declined over the past three decades, offering some reassurance for treatment strategies.
Children Bear the Highest Disease Burden
The findings also showed that children aged five to nine years experience the highest number of typhoid infections and antibiotic-resistant cases. Meanwhile, children between six months and four years face the highest rates of hospitalisation and death, underscoring the vulnerability of younger age groups.
Priority States Identified for Typhoid Vaccination
Given the disease burden and resistance patterns, the study identified Delhi, Maharashtra and Karnataka as priority states for introducing the typhoid conjugate vaccine. This single-dose vaccine provides long-lasting protection and could significantly reduce transmission and severe outcomes.
Routine Immunisation Alone May Not Be Enough
However, the researchers cautioned that relying solely on routine immunisation—which administers the typhoid conjugate vaccine at around nine months of age—would not be sufficient for rapid disease control. Since older children and adults also carry a substantial burden, it could take decades to achieve meaningful population-level protection through routine vaccination alone.
Strengthening Measures to Tackle Antimicrobial Resistance
Finally, the authors stressed the urgent need for comprehensive measures to curb antimicrobial resistance. These include stronger antimicrobial stewardship programmes, improved infection prevention and control practices, and enhanced monitoring of both antibiotic resistance and antibiotic usage across the country.
Robust Data Sources Underpin the Analysis
The analysis drew on multiple data sources, including the Surveillance for Enteric Fever in India study (2017–2020) and the Global Burden of Disease (GBD) 2021 study, ensuring a robust and comprehensive assessment of India’s typhoid burden and resistance trends.