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.