Karachi: Widely used “Typhi Dot” test for diagnosing typhoid in Pakistan is unreliable and misleading, yet continues to be prescribed by doctors and offered by diagnostic laboratories across the country, health experts said warning that the test is benefiting clinics and labs financially but harming patients, causing misdiagnosis, unnecessary antibiotic use and fueling the dangerous spread of drug-resistant typhoid in the country.
Senior infectious disease specialist Dr. Naseem Salahuddin of Indus Hospital said small private clinics routinely prescribe Typhi Dot for patients with simple fevers, while dozens of laboratories across Pakistan are still conducting the test.
“The Typhi Dot test gives false positives in most cases. Based on these results, patients are wrongly diagnosed with typhoid and put on antibiotics. This is directly fueling resistance against life-saving antibiotics,” she told Vitals News.
She added that while labs and clinics continue to make money from this test, it is patients who pay the price. “WHO and the Infectious Diseases Society of Pakistan have rejected this test, but some doctors and labs are still exploiting patients by ordering it. They are playing with public health for profit,” she said.
Assistant Professor Dr. Muhammad Inam Khan of Jinnah Hospital Karachi said the test has no recommendation in clinical textbooks but is still widely practiced, from Karachi to Khyber Pakhtunkhwa.
“Quacks and even some general practitioners knowingly order it. The result is almost always positive — up to 99 percent — which is false. Patients are then wrongly put on treatment for typhoid when they don’t even show the symptoms,” he said.
Dr. Inam said patients are often subjected to two-week courses of ceftriaxone injections on the basis of Typhi Dot results. “Ceftriaxone is a vital and expensive antibiotic. Its misuse is driving resistance, and Pakistan is now seeing cases of typhoid resistant to nearly all available drugs. Wrong diagnostic practices are at the root of this crisis,” he warned.
Public health authorities including the National Institute of Health (NIH) have already directed that Typhidot and Widal tests should no longer be used to confirm typhoid and recommended blood culture as the only reliable diagnostic method. However, they acknowledged that many laboratories, particularly in flood-affected and underserved areas, continue to use these outdated tests, fueling misdiagnosis and rising drug-resistant typhoid.
Experts say that while a blood culture test costs around Rs 2,000, smaller labs push the cheaper Typhidot, priced as low as Rs 150, because it is quicker, requires less equipment and earns commissions for the referring doctors. Many clinics, especially in peri-urban and rural areas, lack the capacity for blood cultures and send patients for Typhidot or Widal tests, which are notorious for false positives and lead to inappropriate prescriptions of antibiotics. This misuse has been directly tied to the alarming spread of extensively drug-resistant typhoid in Pakistan.
They added that while some leading laboratories have stopped offering Typhidot, hundreds of smaller labs and thousands of roadside clinics continue to rely on it. Pakistan already reports hundreds of thousands of typhoid cases every year and drug-resistant strains have been on the rise since 2016.
“Antibiotic resistance is shrinking our treatment options. If we continue with these wrong practices, even the few medicines left will stop working,” Dr. Inam warned. “The government must ban the import of Typhidot kits and take strict action against quacks and smaller labs who are thriving on this test. Otherwise, the crisis will spiral further out of control.”
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