What is the treatment for typhoid dysentery?

From the Guidelines

Typhoid dysentery treatment should involve antibiotics, with ciprofloxacin being a potential option, however, the most recent and highest quality study 1 recommends ciprofloxacin oral at 15 mg kg−1 twice daily for 7-10 days for typhoid, which can be applied to typhoid dysentery.

Treatment Overview

The treatment of typhoid dysentery typically involves the use of antibiotics to target the causative bacteria, Salmonella typhi or Shigella.

• The choice of antibiotic is crucial and should be based on the most recent guidelines and resistance patterns.
• Supportive care, including oral rehydration solution or IV fluids for dehydration, antipyretics like acetaminophen for fever, and proper nutrition, is equally important.

Antibiotic Options

• Ciprofloxacin is a commonly used antibiotic for typhoid dysentery, with a recommended dose of 15 mg kg−1 twice daily for 7-10 days, as per the study 1.
• Alternative antibiotics include ceftriaxone (1-2 grams daily for 10-14 days) or azithromycin (1 gram initially, then 500 mg daily for 5-7 days), which can be used if the bacteria is susceptible.
• It is essential to note that antibiotic resistance is a growing concern, and the choice of antibiotic should be guided by local resistance patterns and the most recent guidelines.

Supportive Care

• Oral rehydration solution or IV fluids for dehydration
• Antipyretics like acetaminophen for fever
• Proper nutrition to support the recovery process

Important Considerations

• Patients should continue treatment for the full prescribed duration, even if symptoms improve.
• Self-medication with antidiarrheals should be avoided, as it can worsen the condition.
• Strict hygiene practices should be maintained to prevent transmission to others.
• Treatment should begin promptly, as typhoid dysentery can lead to serious complications if left untreated, including intestinal perforation and sepsis, as highlighted in the study 1.

From the FDA Drug Label

Typhoid Fever (Enteric Fever) caused by Salmonella typhi. The treatment for typhoid dysentery is ciprofloxacin (PO), as it is indicated for the treatment of Typhoid Fever (Enteric Fever) caused by Salmonella typhi 2.

From the Research

Treatment for Typhoid Dysentery

• The treatment for typhoid dysentery typically involves the use of antimicrobial agents, with the selection of the agent based on knowledge of the susceptibility patterns of locally isolated Shigella strains 3.
• Chloramphenicol is a commonly used drug for the treatment of typhoid fever, but it is associated with a 3% rate of chronic carriage, a high relapse rate, and, in rare cases, aplastic anemia 3.
• Alternative drugs such as ciprofloxacin, ceftriaxone, and azithromycin have been used to treat typhoid fever, with ciprofloxacin being effective against fully sensitive Salmonella typhi and antibiotic-resistant strains 4, 5, 6.
• Ceftriaxone has been shown to be an effective treatment for adults and children with enteric fever, with few adverse effects, and may be used as an alternative to fluoroquinolones and azithromycin 5, 7.
• The choice of antimicrobial agent should take into account current, local resistance patterns and the route of administration 5.

Antimicrobial Resistance

• The emergence of multidrug-resistant typhoid fever is a major public health problem, and the use of antimicrobial agents should be guided by knowledge of local resistance patterns 4.
• The widespread emergence and spread of strains resistant to chloramphenicol, ampicillin, and trimethoprim have limited the treatment options for typhoid fever, and the use of ciprofloxacin and other fluoroquinolones has been questioned due to increasing reports of resistance 4.
• The development of extended-spectrum beta-lactamases (ESBLs) in typhoidal Salmonellae poses a new challenge and limits the therapeutic options, leaving only tigecycline and carbapenems as secondary antimicrobial drugs 4.

Treatment Outcomes

• The treatment outcomes for typhoid dysentery vary depending on the antimicrobial agent used, with ceftriaxone and ciprofloxacin being effective in reducing clinical failure, microbiological failure, and relapse 5, 7, 6.
• The use of ceftriaxone has been associated with a shorter time to defervescence and a lower rate of convalescent fecal carriage compared to fluoroquinolones 5, 7.
• The choice of antimicrobial agent should be guided by the severity of the disease, the presence of complications, and the susceptibility patterns of the isolated organism 3, 4, 5.