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Antimicrobial resistance is an ongoing issue in the treatment of typhoid fever. Resistance to first-line antimicrobials and extensively drug resistant (XDR) <i>Salmonella</i> Typhi isolates in Pakistan have left azithromycin as the only remaining effective oral treatment. Here, we report the emergence of organisms with a single point mutation in <i>acrB</i> gene, implicated in azithromycin resistance, in a <i>S.</i> Typhi isolate from Pakistan. The isolation of this organism is worrisome and highlights the significance of the introduction of typhoid conjugate vaccine in South Asia.<b>IMPORTANCE</b> The emergence of XDR <i>Salmonella</i> Typhi in Pakistan has left azithromycin as the only viable oral treatment option. Here, we report the detection of an azithromycin resistance-associated mutation in one <i>S.</i> Typhi isolate. This finding is important because any possible spread of azithromycin resistance in <i>S.</i> Typhi isolates would make it nearly impossible to treat in outpatient settings due to the need of injectable antibiotics. Our findings also signify the importance of introduction of typhoid conjugate vaccine in regions of endemicity such as Pakistan.

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Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.