What are the recommended doses for treating typhoid fever?

Recommended Doses for Treating Typhoid Fever

For adults with typhoid fever, the recommended treatment is ciprofloxacin 500 mg orally twice daily for 10 days, or alternatively ceftriaxone 75 mg/kg/day (maximum 2-4 g/day) intravenously for 5-7 days. 1, 2, 3

Adult Treatment Regimens

First-line Options:

• Fluoroquinolones:
  • Ciprofloxacin: 500 mg orally twice daily for 10 days 1
  • Levofloxacin: 750 mg once daily for 7-14 days 4
  • Ofloxacin: 400 mg twice daily orally 4

Alternative Options:

• Cephalosporins:

  • Ceftriaxone: 75 mg/kg/day IV (maximum 2-4 g/day) for 5-7 days 2, 3
  • Flexible-duration approach: continue ceftriaxone for 5 days after defervescence 2

• Macrolides:

  • Azithromycin: Recommended when fluoroquinolone resistance is suspected 4

Pediatric Treatment Regimens

Children ≥10 years:

• Fluoroquinolones:
  • Ciprofloxacin: 15 mg/kg orally every 12 hours (maximum 500 mg/dose) for 10 days 4, 1

Children <10 years:

• Ceftriaxone: 75 mg/kg/day IV (maximum 2 g/day) in two divided doses until defervescence, then continue for 5 additional days 2
• Ciprofloxacin: 10 mg/kg IV every 8-12 hours or 15 mg/kg orally every 8-12 hours (maximum 500 mg/dose) 4

Special Considerations

For Severe or Complicated Infections:

• Consider dual therapy with two distinct classes of antimicrobials for initial treatment 4
• Longer duration of therapy (14 days) may be required for severe infections 1

For Multidrug-Resistant Strains:

• Fluoroquinolones remain first-line if the organism is susceptible 4
• Azithromycin is recommended when fluoroquinolone resistance is suspected 4
• Ceftriaxone has shown efficacy against resistant strains with rapid blood culture clearance 3

Clinical Response Monitoring

• Mean defervescence time with ceftriaxone treatment is approximately 4-5.4 days 2, 5
• Blood cultures typically become negative within 3 days of starting ceftriaxone therapy 3
• Monitor for clinical improvement and consider changing therapy if no response after 5 days 3

Important Caveats

• Local resistance patterns should guide antimicrobial selection, as resistance to fluoroquinolones is increasing, particularly in South Asia 6
• Cefixime may be less effective than fluoroquinolones with longer time to defervescence 6
• Ceftriaxone appears to have similar efficacy to azithromycin but may lead to faster defervescence 6
• Patients treated with ceftriaxone may have prolonged fever despite negative blood cultures 3
• Chloramphenicol is no longer recommended as first-line therapy due to higher relapse rates compared to ceftriaxone 2, 3