From the Guidelines
Intravenous ceftriaxone is now the preferred first-line agent for treating typhoid fever, especially in patients returned from Asia, due to increasing reports of fluoroquinolone-resistant isolates. This recommendation is based on the high sensitivity of ceftriaxone to Salmonella Typhi and Salmonella Paratyphi, with more than 70% of isolates imported into the UK being resistant to fluoroquinolones, while all isolates reported to the HPA in 2006 were sensitive to ceftriaxone 1.
Key Considerations
- The choice of antibiotic should be guided by the resistance patterns in the region, as multidrug-resistant strains are increasingly common.
- Azithromycin is a suitable oral alternative for uncomplicated disease if fluoroquinolone resistance is confirmed, with resistance being currently rare in the UK 1.
- Treatment should be continued for 14 days to reduce the risk of relapse, with relapse rates for ceftriaxone being less than 8% and azithromycin less than 3% 1.
Treatment Options
- Intravenous ceftriaxone: 1-2 grams daily for 10-14 days
- Azithromycin: 1 gram once, then 500 mg daily for 5-7 days
- Fluoroquinolones (if sensitive): average fever clearance time of less than 4 days, cure rates greater than 96%, and low rates of fecal carriage 1
Important Notes
- Patients should complete the full course of antibiotics even if symptoms improve.
- Staying hydrated and resting during recovery is crucial.
- In severe cases, hospitalization may be necessary for intravenous antibiotics and supportive care.
From the FDA Drug Label
Typhoid Fever (Enteric Fever) caused by Salmonella typhi. The antibiotic used to treat typhoid is ciprofloxacin 2.
From the Research
Antibiotics Used for Typhoid
- Azithromycin is an effective alternative for the treatment of uncomplicated typhoid fever 3, 4, 5, 6, 7
- Ceftriaxone has shown 100% susceptibility in all S. enterica subspecies 3
- Ciprofloxacin susceptibility was 32.91% for S. Typhi and 40.90% for S. Paratyphi A 3
- Gatifloxacin appears to be more effective than ciprofloxacin and ofloxacin for patients infected with bacteria showing decreased ciprofloxacin susceptibility (DCS) 7
- Chloramphenicol susceptibility was >90% 3, but its use is limited due to toxicity and history of plasmid-mediated resistance 7
Treatment Outcomes
- The clinical cure rate was 62% with ciprofloxacin, 71% with Cefixime, and 85% with azithromycin 5
- The mean fever clearance time for patients treated with azithromycin was shorter than that for patients treated with cefixime and ciprofloxacin 5
- Both gatifloxacin and azithromycin showed an excellent efficacy and safety profile for the treatment of typhoid fever 6