The Center For Disease Dynamics, Economics & Policy

Typhoid/Enteric Fever

Clinical definition:

Systemic illness due to S. enterica serotype Typhi or Paratyphi, commonly acquired from ingestion of contaminated food or water. High fever and diarrhea or constipation are common presenting symptoms.

 

Preferred antibiotic choice(s)
Drug Formulation Dosage Duration
For uncomplicated cases from outside of South Asia or Pakistan (low levels quinolone resistance):
Ciprofloxacin (PO) Oral liquid: 250 mg/5 mL (anhydrous); Tablet: 250 mg (as hydrochloride) 500 mg 12 hourly For mild cases: 7 days

For severe cases: 10 days

For uncomplicated cases from South Asia or Pakistan (high levels quinolone resistance):
Azithromycin (PO) Capsule: 250 mg; 500 mg (anhydrous); Oral liquid: 200 mg/5 mL 500 mg daily 3 days
For complicated cases, if patient is unable to take oral medication, or in case of confirmed drug allergy or medical contraindication:
Ceftriaxone (IV, with de-escalation to ciprofloxacin or azithromycin depending on fluoroquinolone resistance) Powder for injection: 250 mg; 1 g (as sodium salt) in vial 2 g daily For mild cases: 7 days

For severe cases: 10 days

Alternative antibiotic choice(s)
Cefixime (PO) Capsule or tablet: 200 mg; 400 mg (as trihydrate); Powder for oral liquid: 100 mg /5 mL 100 mg 12 hourly For mild cases: 7 days

For severe cases: 10 days

 

Principles of Stewardship:

  • Obtain a blood culture prior to starting antibiotic therapy.

Notes:

  • Patients who acquire S. Typhi from Pakistan who have complicated, severe infection should be considered for empirical meropenem due to ongoing outbreak of XDR- Typhi.
  • Median time to fever reduction is 5 days.