From the Guidelines
Typhoid fever is a bacterial infection caused by Salmonella Typhi that requires prompt medical treatment, with intravenous ceftriaxone being the preferred first-line agent due to increasing reports of fluoroquinolone-resistant isolates, especially in patients returned from Asia. The treatment of typhoid fever involves antibiotics, and the choice of antibiotic depends on the severity of the disease and the susceptibility of the bacteria to different antibiotics.
- The symptoms of typhoid fever include persistent high fever, headache, abdominal pain, and sometimes a rash of rose-colored spots.
- The diagnosis of typhoid fever is made by blood culture, which has the highest yield within a week of symptoms onset, and other tests such as stool and urine cultures, which become positive after the first week.
- The treatment of typhoid fever involves antibiotics, with intravenous ceftriaxone being the preferred first-line agent due to increasing reports of fluoroquinolone-resistant isolates, especially in patients returned from Asia 1.
- Alternative antibiotics include azithromycin, which is a suitable oral alternative for uncomplicated disease if fluoroquinolone resistance is confirmed, and cefixime, which has reported treatment failure rates of 4-37.6% 1.
- Patients with typhoid fever should rest, stay hydrated, and manage fever with acetaminophen, and hospitalization may be necessary for severe cases with complications like intestinal perforation or bleeding.
- Prevention of typhoid fever involves practicing good hygiene, consuming safe food and water, and vaccination for those traveling to endemic areas, with two typhoid vaccines (oral and injectable) being licensed in the United States but not recommended routinely, except for travelers to areas where there is moderate to high risk for exposure to Salmonella enterica subspecies enterica serovar Typhi, people with intimate exposure to a documented Salmonella Typhi chronic carrier, and microbiologists and other laboratory personnel routinely exposed to cultures of Salmonella Typhi 1.
From the FDA Drug Label
Typhoid Fever (Enteric Fever) caused by Salmonella typhi. NOTE: The efficacy of ciprofloxacin in the eradication of the chronic typhoid carrier state has not been demonstrated Ciprofloxacin is indicated for the treatment of Typhoid Fever (Enteric Fever) caused by Salmonella typhi 2.
- The drug is effective for the treatment of typhoid fever.
- However, its efficacy in eradicating the chronic typhoid carrier state has not been demonstrated.
From the Research
Typhoid Illness Overview
- Typhoid fever is a serious disease caused by the bacterium Salmonella Typhi, and its treatment is complicated by the emergence of antimicrobial-resistant strains 3, 4, 5, 6, 7.
- The optimum treatment protocol for typhoid fever has not been established, and various antimicrobial regimens have been compared in different studies 3, 4, 5, 6, 7.
Treatment Options
- Azithromycin is commonly used for the treatment of uncomplicated typhoid fever, but its response may be sub-optimal in some patient groups when compared with fluoroquinolones like ciprofloxacin 3, 4, 5.
- Ciprofloxacin is also used to treat typhoid fever, but its effectiveness is reduced in areas with high levels of resistance 4, 6, 7.
- Cefixime is another antibiotic that has been compared with azithromycin and ciprofloxacin for the treatment of uncomplicated typhoid fever 4.
- Chloramphenicol, despite its toxicity, is still used in some developing countries where the bacteria are susceptible to it 6, 7.
Clinical Trials and Studies
- A study published in 2019 compared the treatment responses to azithromycin and ciprofloxacin in uncomplicated Salmonella Typhi infection and found that azithromycin was associated with prolonged bacteraemia and fever clearance times 3.
- Another study published in 2021 compared the clinical cure rates of ciprofloxacin, azithromycin, and cefixime in patients with uncomplicated typhoid fever and found that azithromycin had a higher cure rate 4.
- A review of 20 prospective clinical trials published in 2011 found that azithromycin meets the criteria for effective treatment of typhoid fever better than other drugs 6.
- A retrospective analysis of adult patients with typhoid fever published in 2005 found that ciprofloxacin was the most commonly used antibiotic, but resistance to various antibiotics was a significant problem 7.