Typhoid Fever Treatment Options

Typhoid Fever Treatment

• Quinolone, macrolide, and third-generation cephalosporin antibiotics are preferred for empiric therapy pending sensitivities.
• Sensitivity to quinolones has been steadily declining, and they are no longer fool-proof agents for typhoid fever.
• Azithromycin is the preferred empirical treatment, often given together with ceftriaxone, in developed countries.
• Chloramphenicol is reserved for life-threatening situations where no alternatives are available.

Antimicrobial Therapy

• Salmonella bacteremia is generally treated with a single bactericidal drug for 10-14 days.
• Life-threatening infections should be treated with both a third-generation cephalosporin and a fluoroquinolone until the susceptibilities of antimicrobial agents are known.
• Antimicrobial therapy for endovascular infections should be continued for a minimum of 6 weeks after successful surgery.

Special Considerations

• High-dose ceftriaxone is the best choice for CNS involvement due to optimal penetration of the blood-brain barrier.
• Antibiotic therapy should be reserved for cases of invasive disease in pregnancy, using amoxicillin or cephalosporin.

Diagnosis

Laboratory Tests

• Freshly passed stool is the preferred specimen for isolation of nontyphoidal Salmonella species.
• PCR is performed.
• Bone marrow aspirate and culture is superior to blood culture, since the bacterial concentration in bone marrow is 10 times that of peripheral blood.

Hematology and Chemistry

• The WBC count is usually within the reference range in patients with salmonellosis.
• Approximately one-fourth of patients with typhoid fever are leukopenic, neutropenic, or anemic.
• Thrombocytopenia is neither universal nor diagnostic.
• Mild hepatocellular liver function abnormality is common.

Imaging Studies

• Radiologic findings in salmonellosis are nonspecific.
• Patients older than 50 years with nontyphoidal Salmonella bacteremia should undergo clinical assessments such as CT or MRI to rule out concurrent vascular infections.

Salmonella Gastroenteritis

• Salmonella gastroenteritis is usually a self-limiting disease.
• Fluid and electrolyte replacement may be indicated in severe cases.
• Antibiotics are not routinely used to treat uncomplicated nontyphoidal Salmonella gastroenteritis.

Typhoid Fever

• The clinical course of typhoid fever varies greatly, ranging from fever with little other morbidity to marked multisystem toxemia.
• The incubation period is 10-14 days, and typhoid fever is usually associated with prolonged low-grade fever, dull frontal headache, malaise, myalgia, dry cough, anorexia, and nausea.

Other Presentations of Salmonella Infection

• Urolithiasis or structural abnormalities and immunosuppressive therapy predispose to Salmonella urinary tract infections.
• Relapses can occur, even with appropriate therapy, and the relapse rate is significantly higher in immunosuppressed patients with Salmonella bacteremia.