management
Last edited 02/2020 and last reviewed 03/2021
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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
- 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 (2)
- 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
- 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
- emergence of multiple-drug-resistant (MDR) Salmonella strains, which
are resistant to chloramphenicol, ampicillin, and cotrimoxazole, has changed
treatment options
Reference: