From the Guidelines
The treatment for typhoid fever primarily involves antibiotics, with ceftriaxone (1-2 g daily for 10-14 days) being the preferred choice due to increasing resistance to fluoroquinolones, as reported in the study published in the Journal of Infection in 2009 1.
Key Considerations
- The choice of antibiotic should be based on local resistance patterns and culture results, if available.
- For uncomplicated cases in adults, ceftriaxone is often used, while for children, azithromycin (20 mg/kg/day for 7 days) is frequently recommended, as suggested in the study published in the British Journal of Pharmacology in 2015 1.
- Supportive care, including adequate hydration, fever management with acetaminophen or ibuprofen, and rest, is also essential.
- Patients should continue treatment for the full prescribed duration, even if symptoms improve earlier, to prevent relapse.
Severe Cases
- In severe cases requiring hospitalization, intravenous antibiotics and fluids may be necessary.
- Surgery may be recommended in cases of typhoid intestinal perforation, as reported in the study published in the International Journal of Infectious Diseases in 2020 1.
Prevention
- Vaccination against typhoid fever is recommended for travelers to areas with moderate to high risk of exposure, as well as for people with intimate exposure to a documented Salmonella Typhi chronic carrier, as stated in the guidelines published in Clinical Infectious Diseases in 2017 1.
Important Notes
- Antibiotic resistance is increasingly common in typhoid, so healthcare providers may need to adjust treatment based on local resistance patterns or culture results.
- Proper hygiene during recovery is important to prevent spreading the infection to others, as patients can shed the bacteria in stool for weeks after symptoms resolve.
From the FDA Drug Label
Typhoid Fever (Enteric Fever) caused by Salmonella typhi. The treatment for typhoid is ciprofloxacin (PO), as it is indicated for the treatment of Typhoid Fever (Enteric Fever) caused by Salmonella typhi 2.
- Key points:
- The efficacy of ciprofloxacin in the eradication of the chronic typhoid carrier state has not been demonstrated
- Ciprofloxacin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria 2
From the Research
Treatment Options for Typhoid
- The treatment for typhoid typically involves the use of antibiotics, with the choice of antibiotic depending on the severity of the disease and the presence of any antibiotic resistance 3, 4, 5, 6, 7.
- A 7-day course of a single oral antimicrobial such as ciprofloxacin, cefixime, or azithromycin is commonly used for the treatment of uncomplicated typhoid fever 3.
- However, the emergence of antimicrobial resistance has threatened the effectiveness of these treatment choices, and alternative treatment regimens are being explored 3, 4, 5, 6, 7.
Comparison of Treatment Regimens
- A study comparing azithromycin and ciprofloxacin for the treatment of uncomplicated typhoid fever found that both antibiotics were similarly effective, both clinically and bacteriologically, against typhoid fever caused by both sensitive organisms and multidrug-resistant S. typhi 6.
- Another study comparing ciprofloxacin, azithromycin, and cefixime for the treatment of uncomplicated typhoid fever found that azithromycin had a shorter fever clearance time and a higher clinical cure rate compared to the other two antibiotics 7.
- A randomized controlled trial comparing azithromycin and cefixime combination versus azithromycin alone for the treatment of uncomplicated typhoid fever found that the combination treatment may limit the emergence of resistance if one of the components is active against resistant sub-populations not covered by the other antimicrobial activity 3.
Antibiotic Resistance
- The emergence of multidrug resistance and decreased ciprofloxacin susceptibility in Salmonella enterica serovar Typhi has rendered older drugs ineffective or suboptimal for typhoid fever 4.
- A study found that 88.7% of S. enterica serovar Typhi isolates were multidrug-resistant and 93.5% were nalidixic acid resistant 7.
- The use of alternative antibiotics such as azithromycin and cefixime may be effective in treating typhoid fever caused by multidrug-resistant S. typhi 6, 7.