The Center For Disease Dynamics, Economics & Policy

Typhoid/Enteric Fever

Clinical definition:

A systemic disease caused by Salmonella species. Clinical features include fever, anorexia, headache, vomiting, constipation or diarrhoea, abdominal pain or tenderness, cough, delirium / altered level of consciousness, hepatomegaly or splenomegaly. Where available, the organism may be cultured from blood (first week of illness) or stool (after first week), urine or bone marrow. A chronic carrier state may occur with ongoing shedding of the organism in stool which may result in transmission to others via contaminated food or water.

 

Infant, Child & Adolescent

Preferred antibiotic choice
Drug Formulation Dosage Duration
For patients with severe disease:

Ceftriaxone (IV)

Powder for injection: 250 mg, 1 g (as sodium slat) in vial 50 mg/kg/dose 12 hourly, maximum dose 2 g 12 hourly 10 – 14 days
For mild/moderate disease or as step down therapy for severe disease based on clinical response and antibiotic susceptibility results, if available:

Ciprofloxacin (PO)

Oral liquid: 250 mg/5 mL (anhydrous); Tablet: 250 mg (as hydrochloride) 15 mg/kg/dose 12 hourly, maximum dose 500 mg 12 hourly 10 – 14 days

 

(Total treatment duration including IV therapy, if applicable.)

Alternative antibiotic choice(s) or for confirmed drug allergy or medical contraindication
Drug Formulation Dosage Duration
Ciprofloxacin (IV) Solution for IV infusion: 2 mg/ mL (as hyclate) 10 mg/kg/dose 8-12 hourly, maximum dose 400 mg 8-12 hourly 10 – 14 days
Azithromycin (PO) Capsule: 250 mg; 500 mg (anhydrous). Oral liquid: 200 mg/5 mL 10 mg/kg/dose daily, maximum dose 500 mg 5 days

 

Principles of Stewardship:

  • The patient should ideally be isolated with contact precautions maintained until eradication of the organism from the stool is confirmed on 3 stool samples taken 1 week after completion of antibiotic treatment and every 48 hours thereafter to detect chronic carriage and excretion of the organism.

Notes:

  • Prolonged therapy (4 – 6 weeks) is recommended in invasive disease, including bone infections, and in immunocompromised patients (including HIV infection)