THE combination of poor sanitation, contaminated water and the indiscriminate administration of antibiotics by medical practitioners has turned typhoid into a formidable health threat for millions of Pakistanis, particularly children. As per a report published in this paper, the country has the worst rate of typhoid in South Asia, with the extensively drug-resistant (XDR) strain of ‘superbug’ posing a particularly acute challenge to its feeble health infrastructure. The superbug is resistant to most antibiotic treatments, and there have been several outbreaks of XDR typhoid reported in Pakistan, affecting thousands of children. As some medical experts have cautioned, XDR typhoid may be “the final warning sign” before this waterborne disease takes on more lethal and debilitating forms, with drugs unable to fight infections. Typhoid in general is the result of the poor sanitation situation in Pakistan, which is particularly the case in urban slums. Yet the XDR variety of the ailment is said to be rooted in over-prescription of antibiotics by doctors. Unfortunately, many medical professionals prescribe antibiotics at the drop of a hat, even when the patient can be treated through other methods. Complications also develop when patients do not complete the course as prescribed. Moreover, self-medication has also aided this crisis, as people try to heal themselves by buying drugs without consulting a physician. This can cause more problems than it resolves. There is a need for the state to tackle the XDR typhoid crisis before it develops into a full-blown health emergency. In this regard, the medical community must self-regulate. Physicians should be urged not to prescribe antibiotics unless they are absolutely required. A stricter check on pharmacies by respective provincial health departments is also in order to ensure that drugs are only dispensed after the production of a valid medical prescription. The battle against virulent strains of typhoid can further be strengthened through extensive vaccination. Parents should be counselled to get their wards immunised against typhoid to avoid refusals, while vaccination drives need to be carried out in schools. Youngsters — as well as adults — also need to be taught about proper hygiene practices to ward off ailments. In the longer term, typhoid and a host of other waterborne diseases can be kept at bay if the state ensures that the population has access to clean water, and a healthier environment devoid of filth.