What is the recommended dose and frequency of cefotaxime (Cefotaxime) for treating typhoid fever in adults?

Cefotaxime Dosing for Typhoid Fever in Adults

For adults with typhoid fever, cefotaxime should be administered at a dose of 2 g intravenously every 8 hours (6-hourly) for 10-14 days. 1

Dosage Regimen Details

• Standard dose: 2 g IV every 6-8 hours
• Total daily dose: 6-8 g per day
• Duration: 10-14 days (may be shortened to 5-7 days in patients with good clinical response)

Evidence-Based Rationale

Cefotaxime is highly effective against Salmonella typhi, the causative organism of typhoid fever. It covers approximately 95% of the flora commonly involved in enteric infections, including Escherichia coli, Klebsiella pneumoniae, and other Enterobacteriaceae 1. The recommended dosing achieves excellent tissue penetration with 20-fold killing power after just one dose 1.

Treatment Algorithm

1. Initial therapy: Begin with cefotaxime 2 g IV every 6-8 hours
2. Assessment: Evaluate clinical response within 48-72 hours
   • If improving: Continue current regimen
   • If not improving: Consider adding a second agent or switching therapy
3. Duration adjustment:
   • Uncomplicated cases with good response: Consider stopping after 5-7 days
   • Complicated cases or delayed response: Complete full 10-14 day course

Alternative Options

If cefotaxime is unavailable or contraindicated, consider:

• Ceftriaxone: 2 g IV once or twice daily (alternative third-generation cephalosporin)
• Azithromycin: 1 g orally on day 1, followed by 500 mg daily (for quinolone-resistant strains)
• Ciprofloxacin: 500 mg orally twice daily (only if local resistance patterns permit)

Special Considerations

• Renal impairment: Patients with creatinine clearance <30 mL/min require dose adjustment
• Monitoring: Follow clinical response with daily temperature monitoring; expect defervescence within 4-5 days
• Follow-up: Consider blood cultures after completion of therapy to ensure eradication

Potential Pitfalls

• Resistance concerns: Be aware of local resistance patterns, particularly in areas with high prevalence of extended-spectrum beta-lactamase (ESBL) producing organisms
• Inadequate duration: Premature discontinuation may lead to relapse
• Failure to adjust therapy: If no clinical improvement is seen within 48-72 hours, reassess diagnosis and consider alternative antibiotics

The recommended dosing regimen is based on established guidelines for treating serious infections caused by Enterobacteriaceae, with specific evidence supporting its use in typhoid fever 1. This regimen provides adequate serum and tissue concentrations to effectively eliminate the pathogen while minimizing the risk of treatment failure or relapse.