From the Research
Cefditoren is not typically recommended for treating typhoid fever, and instead, fluoroquinolones, third-generation cephalosporins, or azithromycin are preferred, depending on local resistance patterns. The most recent and highest quality study, a Cochrane Review published in 2022 1, evaluated the effectiveness of cephalosporins for treating enteric fever and found that ceftriaxone is an effective treatment for adults and children with enteric fever, with few adverse effects. However, cefditoren, a third-generation cephalosporin, has not been extensively studied or approved specifically for typhoid treatment.
Treatment Options
For uncomplicated typhoid, ciprofloxacin (500 mg twice daily for 7-10 days) or azithromycin (1 gram on day one, then 500 mg daily for 6 days) are commonly used, as supported by a study published in 2021 2 that found 97.8% of S. Typhi isolates were susceptible to conventional first-line antibiotics, including ciprofloxacin. For severe cases, intravenous ceftriaxone (2 grams daily for 10-14 days) is preferred, as it has been shown to be effective in reducing clinical failure and microbiological failure compared to azithromycin 1.
Resistance Patterns
The choice of antibiotic should be guided by local susceptibility patterns, as resistance is increasingly common, with a study published in 2019 3 finding that 45% of children with enteric fever were culture positive with Salmonella Typhi, and another study published in 2021 2 finding that 97.8% of S. Typhi isolates were resistant or intermediately susceptible to fluoroquinolones.
Essential Components of Typhoid Management
Proper hydration and supportive care are also essential components of typhoid management, in addition to effective antibiotic treatment. A study published in 2011 4 found that azithromycin appears to be a suitable alternate for the treatment of typhoid in the community, while imipenem and cefipime are good options in complicated cases. Another study published in 2010 5 found that the combination of ciprofloxacin and cefotaxime was significantly more effective in vitro in reducing bacterial counts against nalidixic acid-resistant S. Typhi.