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Management

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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  • azithromycin is increasingly used for the empirical treatment of enteric fever

Notes:

  • for many decades, antibiotics such as chloramphenicol, ampicillin, and cotrimoxazole were used for treating enteric fever
    • emergence of multiple-drug-resistant (MDR) Salmonella strains, which are resistant to chloramphenicol, ampicillin, and cotrimoxazole, has changed treatment options (2)
      • second-line antibiotics like the fluoroquinolones (ciprofloxacin, ofloxacin, perfloxacin), third-generation cephalosporins (ceftriaxone, cefotaxime, cefixime), and azithromycin are often now used for treating MDR typhoid fever
        • infections with isolates susceptible to nalidixic acid (prototype fluoroquinolone) respond extremely well to fluoroquinolones
        • the extensive use of fluoroquinolones has since led to the emergence of intermediate and fully fluoroquinolone resistant strains

      • a systematic review concluded that (1):
        • azithromycin appears better than fluoroquinolone drugs in populations that included participants with drug-resistant strains
        • azithromycin may perform better than ceftriaxone

      • azithromycin is increasingly used for the empirical treatment of enteric fever
        • but widespread use of this drug in many parts of South Asia today may rapidly lead to development of resistance, highlighting the importance of good microbiological surveillance
        • some authors have advocated the addition of doxycycline for suspected enteric fever cases in regions of South Asia with high incidence of Rickettsia spp

Reference:


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