Treatment of Typhoid Fever

Chloramphenicol, Cotrimoxazole, Quinolones, Third generation cephalosporins, in addition to steroids are studied here. Chloramphenicol is the gold standard antibiotic, which clears blood from S typhi in a few hours and stool in a few days. Oral administration is preferred. However, resistance, relapse, bone marrow suppression and etc. are major disadvantages. Resistance against cotrimaxazole is high. Quinolones (e.g., ciprofloxacin which is the drug of choice in multidrug resistance) and third generation cephalosporins (e.g., ceftriaxone which is the best choice in children) are used in areas with a high prevalence rate of multidrug-resistant salmonella infection. Glucocorticoid administration is controversial, although it reduces the mortality in severe cases if used for 48 hours, steroid treatment over 48 hours may increase relapse rate. Surgical therapy is usually needed for complications (e.g., bowel perforation). Relapse of typhoid fever should be treated the same as patients with the first attack. Chronic fecal carriers (asymptomatic excretion for a year or more) should receive high doses of Ampicillin or Amoxicillin (100mg/kg/d) plus probenecid (30mg/kg/d) or Co-trimoxazole(160/800 mg twice daily) for at least 6 weeks. Those who have gallstone need cholecystectomy. Iranian studies show that cefixime is effective on all strains. Typhoid fever is a severe systemic infectious disease. Treatment with appropriate antibiotics is essential for recovery. In this article we review some current antibiotics used for the treatment of typhoid fever.