What are the recommended doses and durations of cefexime and ofloxacin for treating typhoid?

Treatment of Typhoid Fever with Cefixime and Ofloxacin

For typhoid fever treatment, ofloxacin should be dosed at 400 mg twice daily for adults and 7.5 mg/kg twice daily for children (maximum 400 mg/dose) for 7-10 days, while cefixime should be dosed at 400 mg daily for adults and 8 mg/kg/day for children for 7-10 days. 1, 2

Ofloxacin Dosing

Adults

• 400 mg orally twice daily for 7-10 days 1, 3
• Total daily dose: 800 mg
• Can be taken with or without food, but taking with food may reduce gastrointestinal side effects 1

Children

• 7.5 mg/kg orally every 12 hours (maximum 400 mg/dose) for 7-10 days 1
• Only use in children when benefits clearly outweigh risks due to potential effects on bone and cartilage growth 1

Cefixime Dosing

Adults

• 400 mg orally once daily for 7-10 days 2
• Can be administered without regard to food 2

Children (6 months or older)

• 8 mg/kg/day orally 2
• Can be given as a single daily dose or divided into two doses (4 mg/kg every 12 hours) 2
• Available in two concentrations: 100 mg/5 mL and 200 mg/5 mL suspension 2

Dose Adjustments for Renal Impairment

Ofloxacin

• For creatinine clearance 20-50 mL/min: Normal dose once daily 1
• For creatinine clearance <20 mL/min: Half the usual dose once daily 1

Cefixime

• For creatinine clearance 21-59 mL/min or patients on hemodialysis: 65% of normal dose 2
• For creatinine clearance ≤20 mL/min or continuous peritoneal dialysis: 43% of normal dose 2

Clinical Considerations

Drug Selection

• Ofloxacin has shown excellent efficacy against multidrug-resistant Salmonella typhi with 100% clinical and bacteriological cure rates 3, 4
• Cefixime is an alternative when fluoroquinolones cannot be used, though it has longer fever clearance times (8.5 days vs 4.4 days for ofloxacin) 5

Treatment Duration

• The recommended treatment duration for typhoid fever is 7-10 days for both medications 1
• Longer courses (14 days) have been used successfully with ofloxacin in some studies 3

Monitoring

• Monitor for clinical improvement, particularly fever resolution (typically within 3-5 days with ofloxacin, longer with cefixime) 1, 5
• Watch for adverse effects:
  • Ofloxacin: gastrointestinal disturbances, neurological effects, skin reactions 1
  • Cefixime: diarrhea (16%), nausea (7%), loose stools (6%), abdominal pain (3%) 2

Special Precautions

Ofloxacin

• Avoid in pregnancy due to potential teratogenic effects 1
• Use with caution in children due to potential effects on bone and cartilage growth 1
• Avoid concurrent administration with antacids, sucralfate, and divalent or trivalent cations 1

Cefixime

• Safe to use in pregnancy if clearly needed 2
• Consider discontinuing nursing temporarily during treatment 2
• Not established for infants under 6 months of age 2

Common Pitfalls to Avoid

1. Using suboptimal doses that may lead to treatment failure and resistance
2. Not adjusting doses in renal impairment
3. Using ofloxacin in children without careful consideration of risks vs. benefits
4. Stopping treatment prematurely when symptoms improve
5. Not considering local resistance patterns when selecting therapy

Remember that third-generation cephalosporins like cefixime remain effective options for typhoid fever, especially in areas with emerging fluoroquinolone resistance 6.