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Treatment and prevention of typhoid fever

Author
Elizabeth L Hohmann, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD

INTRODUCTION

Typhoid fever and paratyphoid fever (also known as enteric fever, but collectively referred to here as typhoid fever) are severe systemic illnesses caused by Salmonella typhi and Salmonella paratyphi, respectively, and are characterized by sustained fever and abdominal symptoms. The treatment and prevention of typhoid fever will be reviewed here. The epidemiology, pathogenesis, clinical manifestations, and diagnosis of typhoid fever are discussed separately. (See "Pathogenesis of typhoid fever" and "Epidemiology, microbiology, clinical manifestations, and diagnosis of typhoid fever".)

ANTIMICROBIAL RESISTANCE

Treatment of typhoid fever has been complicated by the development and rapid dissemination of typhoidal organisms resistant to ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol. Additionally, development of increasing resistance to fluoroquinolones is a growing challenge.

Multidrug resistance — Multidrug-resistant (MDR) strains (ie, those resistant to ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol) are prevalent worldwide.

MDR strains of S. typhi and S. paratyphi have caused numerous outbreaks in endemic regions, including South and Southeast Asia, China, and Africa [1-3]. Because of this, ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol have no longer been used as first-line agents for treatment of typhoid fever. Subsequently, some locations have reported a decrease in the prevalence of MDR strains. As an example, in a surveillance study from Kolkata, India conducted from 2009 to 2013, 18 percent of S. typhi and no S. paratyphi isolates were MDR [4]. Nevertheless, MDR strains remain frequent worldwide. In locations such as Bangladesh, Vietnam, and Cambodia, MDR isolates account for the vast majority of S. typhi [5,6]. Prevalence of MDR strains varies throughout Africa, the Middle East, and Central Asia, from 10 to 80 percent, depending on the country [7,8]. Genome sequencing and analysis of international isolates has identified a predominant MDR S. typhi strain, H58, that has disseminated throughout Asia and Africa, displacing more susceptible strains and driving ongoing MDR epidemics [9].

These patterns of resistance are reflected in travelers returning to nonendemic regions. In an analysis of over 1000 isolates submitted to the United States Centers for Disease Control and Prevention (CDC) between 2008 and 2012, most of which were from infections acquired in South Asia, 12 percent of S. typhi and no S. paratyphi isolates were MDR strains [10]. A similar prevalence of MDR strains was reported from a surveillance study in Switzerland between 2002 and 2013 [11].

                    

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