From the Guidelines
Antibiotic of Choice for Typhoid Fever
The antibiotic of choice for typhoid fever is ceftriaxone, administered at a dose of 2 grams intravenously every 24 hours for 7-14 days 1.
- This recommendation is based on the high prevalence of fluoroquinolone-resistant isolates of Salmonella Typhi, particularly in patients returning from Asia 1.
- Azithromycin may be used as an alternative, particularly in areas with high resistance to fluoroquinolones, at a dose of 1 gram orally on the first day, followed by 500 mg orally every 24 hours for 6-7 days 1.
- In cases where oral therapy is suitable, ciprofloxacin may be considered, at a dose of 500-750 mg orally every 12 hours for 7-14 days, although its use is limited by the high prevalence of resistance 1.
- The choice of antibiotic should be guided by local resistance patterns and the severity of the disease, with ceftriaxone being the preferred option in severe cases or where fluoroquinolone resistance is suspected 1.
- It is essential to continue treatment for 14 days to reduce the risk of relapse, and the addition of steroids may be helpful in severe cases 1.
From the FDA Drug Label
Typhoid Fever (Enteric Fever) caused by Salmonella typhi. The antibiotic of choice for typhoid (Salmonella Typhi) fever is ciprofloxacin 2.
From the Research
Antibiotic Treatment for Typhoid Fever
The choice of antibiotic for treating typhoid fever (Salmonella Typhi) depends on various factors, including the susceptibility of the strain and the presence of resistance.
- High-dose intravenous ceftriaxone (4 g per day) is always efficient in first-line therapy 3.
- Azithromycin can be used successfully for patients infected with reduced ciprofloxacin susceptibility isolates 3.
- Ciprofloxacin represents a useful treatment option in areas where multiresistant strains are likely to be encountered 4.
- Fluoroquinolones, such as ciprofloxacin and ofloxacin, have been shown to be effective in treating typhoid fever, especially in areas with known resistance to older first-line antibiotics 5.
Considerations for Antibiotic Choice
When choosing an antibiotic for typhoid fever, it is essential to consider the following factors:
- Susceptibility of the strain to the antibiotic 3, 4.
- Presence of resistance to commonly used antibiotics 3, 5.
- Local resistance patterns 5.
- Severity of the disease and the patient's overall health 6, 4.
Alternative Treatment Options
Alternative treatment options, such as azithromycin and cefixime, are being investigated for the treatment of typhoid fever 7.
- A combination of azithromycin and cefixime may be a better option for the treatment of clinically suspected and culture-confirmed typhoid fever in South Asia 7.
- Gatifloxacin, a newer fluoroquinolone, has been shown to remain effective in some regions where resistance to older fluoroquinolones has developed 5.