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Treatment and prevention of enteric (typhoid and paratyphoid) fever

Edward T Ryan, MD, DTMH
Jason Andrews, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD


Enteric fever is characterized by severe systemic illness with fever and abdominal pain [1]. The organism classically responsible for the enteric fever syndrome is Salmonella enterica serotype Typhi (formerly S. typhi). Other Salmonella serotypes, particularly S. enterica serotypes Paratyphi A, B, or C, can cause a similar syndrome; however, it is usually not clinically useful or possible to reliably predict the causative organism based on clinical findings [2]. The term "enteric fever" is a collective term that refers to both typhoid and paratyphoid fever, and "typhoid" and "enteric fever" are often used interchangeably.

The treatment and prevention of enteric fever will be reviewed here. The epidemiology, pathogenesis, clinical manifestations, and diagnosis of enteric fever are discussed separately. (See "Pathogenesis of enteric (typhoid and paratyphoid) fever" and "Epidemiology, microbiology, clinical manifestations, and diagnosis of enteric (typhoid and paratyphoid) fever".)


Treatment of enteric fever has been complicated by the development and rapid global spread 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 [3-5]. Because of this, ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol are no longer used as first-line agents for treatment of enteric fever.

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Literature review current through: Nov 2017. | This topic last updated: Nov 27, 2017.
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