Recommended Dose of Ceftriaxone for Typhoid Fever Treatment
For patients with fever and a positive typhoid test, the recommended dose of ceftriaxone is 50-80 mg/kg/day (maximum 2g/day) intravenously or intramuscularly for 5-7 days. 1, 2
First-line Treatment Options
- Ceftriaxone is an appropriate first-line parenteral therapy for typhoid fever, particularly in areas with high fluoroquinolone resistance 1, 2
- For adults, a standard dose of 1-2g daily is recommended, while children should receive 50-80 mg/kg/day 1, 3
- Treatment duration should typically be 5-7 days, though this may be extended in complicated cases 1, 4
- A flexible-duration approach can be used, continuing ceftriaxone for 5 days after defervescence (fever resolution) 3
Dosing Based on Patient Age
- Adults: 1-2g IV/IM daily for 5-7 days 1, 2
- Children: 50-80 mg/kg/day IV/IM (maximum 2g/day) for 5-7 days 1, 5
- Neonates: Not typically indicated as typhoid fever is rare in this age group, but if needed: 50 mg/kg/day given every 24 hours 1
Administration Considerations
- Ceftriaxone can be administered as a once-daily dose, which simplifies treatment regimens 5
- For severe cases requiring hospitalization, initial intravenous administration is preferred 1, 2
- Once clinical improvement occurs, transition to oral therapy (such as azithromycin) may be considered 2, 6
Clinical Response and Monitoring
- Mean defervescence (fever resolution) time with ceftriaxone is approximately 4-5 days 7, 4
- Blood cultures typically become negative earlier with ceftriaxone compared to other treatments like chloramphenicol 4
- Therapeutic blood levels of ceftriaxone remain well above the MICs for Salmonella typhi strains throughout the 24-hour dosing interval 8
Alternative Treatment Options
- In areas with high fluoroquinolone resistance, azithromycin (20 mg/kg/day, maximum 1g/day) for 7 days is another recommended first-line option 2, 6
- For fully susceptible strains, fluoroquinolones remain effective alternatives 2, 6
- In severe cases, adding steroids may be helpful 1
Important Considerations and Pitfalls
- Always obtain blood cultures before starting antibiotics when possible, as they have the highest yield within the first week of symptom onset 1, 6
- Be aware that over 70% of S. typhi and S. paratyphi isolates imported into the UK are resistant to fluoroquinolones, making ceftriaxone or azithromycin better empiric choices 1
- Prolonged fever despite appropriate treatment can occur in some patients treated with ceftriaxone and should not necessarily prompt a change in therapy unless clinical deterioration occurs 4
- Relapse rates with ceftriaxone are generally lower (<8%) compared to some other treatments 1, 3