Typhoid Management in Adults

WHO Guidelines for the Management of Typhoid Fever 2011

Rocephin - Ceftriaxone

ü More than 90% of patients can be managed at home with PO antimicrobial, minimal nursing care, and close medical follow-up for complications or failure to respond to therapy.

ü Patient with neurological complications (delirium, obtundation or stupor) should be immediately evaluated for meningitis by examination of CSF. If findings are normal and typhoid fever is suspected, patient (both adult and children) should immediately be treated with high-dose IV dexamethasone:

o Initial dose of 3 mg/kg by slow IV infusion over 30 minutes, followed 6 hours later by 1mg/kg every 6 hours for a total of eight doses.

UpToDate Recommendation:

First-line therapy

Ciprofloxacin 500mg BD or Ofloxacin 400mg BD, either orally or parentally for 7 – 10 days

Alternatives for fluoroquinolone resistant isolates:

· Ceftriaxone 2 – 3 g OD parenterally or Cefixime 20 mg/kg/day PO in two divided doses for 7 - 14 days

· Azithromycin 1g PO for one dose followed by 500mg OD for 5 – 7 days, or 1g PO OD for 5 days

· Chlorampheicol 2 – 3 g/day PO in four divided doses for 14 days

References:

1. WHO. Guidelines for the management of typhoid fever. July 2011. http://apps.who.int/medicinedocs/documents/s20994en/s20994en.pdf

2. UpToDate. Treatment and prevention of typhoid fever. http://www.uptodate.com/contents/treatment-and-prevention-of-typhoid-fever?source=search_result&search=typhoid&selectedTitle=2~86#H2