Management of carriers

Carriers should be excluded from handling food or water.

Consult local microbiology advice regarding the use of antibiotic treatment for the carrier state.

• treatment of chronic carriage may require a combination of medical and surgical interventions
  • antibiotic treatment
    • fluoroquinolones are commonly used in the treatment of chronic carriage
    • a prolonged treatment course with azithromycin may be of use in the management of chronic carriers infected with fluoroquinolone-resistant isolates (1,2)

The carrier state may prove difficult to eradicate particularly if the patient has chronic gallbladder disease. However, this alone should not be an indication for cholecystectomy as infection may persist in the liver, and the patient remain a carrier. Cholecystectomy should only be performed as means of treating the gallbladder disease

• cholecystectomy may be required in the presence of cholelithiasis
  • the efficacy of which is likely to be improved by concomitant administration of antibiotics

In patients with chronic urinary carriage resulting from infection with Schistosoma haematobium, the schistosomiasis should be treated with praziquantel before the S. enterica serotype typhi infection (1)

Reference:

1. . Parry CM, Hien TT, Dougan G, et al. Typhoid fever. N Engl J Med 2002; 347:1770–1782
2. Gibbani MM et al. Typhoid and paratyphoid fever: a call to action.Curr Opin Infect Dis. 2018 Oct;31(5):440-44