Typhoid fever medical therapy: Difference between revisions
Jump to navigation
Jump to search
(→Adults) |
Aysha Aslam (talk | contribs) No edit summary |
||
| (29 intermediate revisions by 3 users not shown) | |||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Typhoid fever}} | {{Typhoid fever}} | ||
{{CMG}}; {{AE}}{{SR}}, {{ | {{CMG}}; {{AE}}{{SR}}, {{AAA}} | ||
== Overview == | == Overview == | ||
The mainstay of therapy for typhoid fever is antimicrobial therapy. Patients with uncomplicated typhoid fever are treated with either [[Azithromycin]] or a [[fluoroquinolone]] whereas patients with severe disease are treated with either [[Ceftriaxone]], [[Cefotaxime]], or a [[fluoroquinolone]]. | The mainstay of therapy for typhoid fever is [[antimicrobial]] therapy. Patients with uncomplicated typhoid fever are treated with either [[Azithromycin]] or a [[fluoroquinolone]], whereas patients with severe or complicated forms of the disease are treated with either [[Ceftriaxone]], [[Cefotaxime]], or a [[fluoroquinolone]]. | ||
== Medical therapy == | == Medical therapy == | ||
[[Antimicrobial]] therapy is recommended for all patients who develop typhoid fever. Adults and children suffering from typhoid fever require different courses of treatment. | |||
===Adults=== | ===Adults=== | ||
*The mainstay of therapy in adults is the administration of | *The mainstay of therapy in adults is the administration of [[fluoroquinolone|fluoroquinolones]] due to rapid response rate.<ref>Gotuzzo, Eduardo, and Carlos Carrillo. "Quinolones in typhoid fever." Infectious Diseases in Clinical Practice 3.5 (1994): 345-351.</ref><ref>White, Nicholas J., and Christopher M. Parry. "The treatment of typhoid fever." Current opinion in infectious disases 9.5 (1996): 298-302</ref><ref name="pmid10093945">{{cite journal| author=Cao XT, Kneen R, Nguyen TA, Truong DL, White NJ, Parry CM| title=A comparative study of ofloxacin and cefixime for treatment of typhoid fever in children. The Dong Nai Pediatric Center Typhoid Study Group. | journal=Pediatr Infect Dis J | year= 1999 | volume= 18 | issue= 3 | pages= 245-8 | pmid=10093945 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10093945 }} </ref><ref name="pmidhttp://dx.doi.org/10.1016/S0140-6736(13)62708-7 |">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=http://dx.doi.org/10.1016/S0140-6736(13)62708-7 | | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref> | ||
*Other agents used due to emerging resistance | *Other agents used due to emerging resistance to [[fluoroquinolone|fluoroquinolones]] are third-generation cephalosorins and [[Azithromycin]]. | ||
====Fluoroquinolones==== | ====Fluoroquinolones==== | ||
* | *Mainstay of therapy in regions which demonstrates antibiotic susceptiblity to fluoroquinolones<ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854 }} </ref> | ||
* | *Bactericidial; concentrates intracellularly and in bile | ||
*Early defervescence less than 4 days<ref name="pmid7986000">{{cite journal| author=Smith MD, Duong NM, Hoa NT, Wain J, Ha HD, Diep TS et al.| title=Comparison of ofloxacin and ceftriaxone for short-course treatment of enteric fever. | journal=Antimicrob Agents Chemother | year= 1994 | volume= 38 | issue= 8 | pages= 1716-20 | pmid=7986000 | doi= | pmc=284627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7986000 }} </ref> | *Early defervescence (less than 4 days)<ref name="pmid7986000">{{cite journal| author=Smith MD, Duong NM, Hoa NT, Wain J, Ha HD, Diep TS et al.| title=Comparison of ofloxacin and ceftriaxone for short-course treatment of enteric fever. | journal=Antimicrob Agents Chemother | year= 1994 | volume= 38 | issue= 8 | pages= 1716-20 | pmid=7986000 | doi= | pmc=284627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7986000 }} </ref> | ||
*Cure rate | *Cure rate of 96 percent | ||
*Relapse and carrier state | *Relapse and carrier state of less than 2 percent<ref name="pmid19493939">{{cite journal| author=Thaver D, Zaidi AK, Critchley J, Azmatullah A, Madni SA, Bhutta ZA| title=A comparison of fluoroquinolones versus other antibiotics for treating enteric fever: meta-analysis. | journal=BMJ | year= 2009 | volume= 338 | issue= | pages= b1865 | pmid=19493939 | doi=10.1136/bmj.b1865 | pmc=2690620 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19493939 }} </ref><ref>Girgis, Nabil I., et al. "Azithromycin versus ciprofloxacin for treatment of uncomplicated typhoid fever in a randomized trial in Egypt that included patients with multidrug resistance." Antimicrobial agents and chemotherapy 43.6 (1999): 1441-1444.</ref> | ||
====Third generation cephalosporins==== | ====Third-generation cephalosporins==== | ||
*First line agent in adults | *First-line agent in adults with fluoroquinolone resistance<ref name="pmid15138078">{{cite journal| author=Parry CM| title=The treatment of multidrug-resistant and nalidixic acid-resistant typhoid fever in Viet Nam. | journal=Trans R Soc Trop Med Hyg | year= 2004 | volume= 98 | issue= 7 | pages= 413-22 | pmid=15138078 | doi=10.1016/j.trstmh.2003.10.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15138078 }} </ref> | ||
* | *Main agents include ceftriaxone, cefixime, cefotaxime, and cefoperazone<ref name="pmid9296095">{{cite journal| author=Rastegar Lari A, Validi N, Ghaffarzadeh K, Shamshiri AR| title=In vitro activity of cefixime versus ceftizoxime against Salmonella typhi. | journal=Pathol Biol (Paris) | year= 1997 | volume= 45 | issue= 5 | pages= 415-9 | pmid=9296095 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9296095 }} </ref><ref>White, Nicholas J., and Christopher M. Parry. "The treatment of typhoid fever." Current opinion in infectious diseases 9.5 (1996): 298-302.</ref> | ||
*Defervescence averages one week<ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854 }} </ref> | *Defervescence averages one week<ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854 }} </ref> | ||
*Cure rate 95 percent | *Cure rate of 95 percent | ||
*Relapse and carrier rate less than 3 percent | *Relapse and carrier rate of less than 3 percent | ||
====Azithromycin==== | ====Azithromycin==== | ||
*First line agent in adults | *First-line agent in adults with fluoroquinolone or third-generation cephalsporin resistance<ref name="pmid18493312">{{cite journal| author=Dolecek C, Tran TP, Nguyen NR, Le TP, Ha V, Phung QT et al.| title=A multi-center randomised controlled trial of gatifloxacin versus azithromycin for the treatment of uncomplicated typhoid fever in children and adults in Vietnam. | journal=PLoS One | year= 2008 | volume= 3 | issue= 5 | pages= e2188 | pmid=18493312 | doi=10.1371/journal.pone.0002188 | pmc=2374894 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18493312 }} </ref><ref name="pmid24198224">{{cite journal| author=Meltzer E, Stienlauf S, Leshem E, Sidi Y, Schwartz E| title=A large outbreak of Salmonella Paratyphi A infection among israeli travelers to Nepal. | journal=Clin Infect Dis | year= 2014 | volume= 58 | issue= 3 | pages= 359-64 | pmid=24198224 | doi=10.1093/cid/cit723 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24198224 }} </ref> | ||
*Excellent intracellular concentration<ref name="pmid8396080">{{cite journal| author=Panteix G, Guillaumond B, Harf R, Desbos A, Sapin V, Leclercq M et al.| title=In-vitro concentration of azithromycin in human phagocytic cells. | journal=J Antimicrob Chemother | year= 1993 | volume= 31 Suppl E | issue= | pages= 1-4 | pmid=8396080 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8396080 }} </ref><ref>Chinh, Nguyen Tran, et al. "A randomized controlled comparison of azithromycin and ofloxacin for treatment of multidrug-resistant or nalidixic acid-resistant enteric fever." Antimicrobial agents and chemotherapy 44.7 (2000): 1855-1859.</ref> | *Excellent intracellular concentration<ref name="pmid8396080">{{cite journal| author=Panteix G, Guillaumond B, Harf R, Desbos A, Sapin V, Leclercq M et al.| title=In-vitro concentration of azithromycin in human phagocytic cells. | journal=J Antimicrob Chemother | year= 1993 | volume= 31 Suppl E | issue= | pages= 1-4 | pmid=8396080 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8396080 }} </ref><ref>Chinh, Nguyen Tran, et al. "A randomized controlled comparison of azithromycin and ofloxacin for treatment of multidrug-resistant or nalidixic acid-resistant enteric fever." Antimicrobial agents and chemotherapy 44.7 (2000): 1855-1859.</ref> | ||
*Defervescence 4 to 6 days<ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854 }} </ref> | *Defervescence of 4 to 6 days<ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854 }} </ref> | ||
*Cure rate 95 percent<ref>Butler, Thomas, et al. "Treatment of typhoid fever with azithromycin versus chloramphenicol in a randomized multicentre trial in India." Journal of Antimicrobial Chemotherapy 44.2 (1999): 243-250.</ref> | *Cure rate of 95 percent<ref>Butler, Thomas, et al. "Treatment of typhoid fever with azithromycin versus chloramphenicol in a randomized multicentre trial in India." Journal of Antimicrobial Chemotherapy 44.2 (1999): 243-250.</ref> | ||
*Relapse and carrier rate less than 3 percent | *Relapse and carrier rate of less than 3 percent | ||
===Children=== | ===Children=== | ||
*The mainstay of therapy | *The mainstay of therapy for children in United States is third-generation cephaloporins due to suspected skeletal and tendinous side effects of fluoroquinolones in children.<ref name="pmid9402381">{{cite journal| author=Burkhardt JE, Walterspiel JN, Schaad UB| title=Quinolone arthropathy in animals versus children. | journal=Clin Infect Dis | year= 1997 | volume= 25 | issue= 5 | pages= 1196-204 | pmid=9402381 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9402381 }} </ref><ref>Phuong, Cao Xuan Thanh, et al. "A comparative study of ofloxacin and cefixime for treatment of typhoid fever in children." The Pediatric infectious disease journal 18.3 (1999): 245-248.</ref><ref>Memon, IQBAL AHMAD, Abdul Gaffar Billoo, and HAMIDA IQBAL Memon. "Cefixime: an oral option for the treatment of multidrug-resistant enteric fever in children." Southern medical journal 90.12 (1997): 1204-1207.</ref><ref name="pmid7567290">{{cite journal| author=Girgis NI, Sultan Y, Hammad O, Farid Z| title=Comparison of the efficacy, safety and cost of cefixime, ceftriaxone and aztreonam in the treatment of multidrug-resistant Salmonella typhi septicemia in children. | journal=Pediatr Infect Dis J | year= 1995 | volume= 14 | issue= 7 | pages= 603-5 | pmid=7567290 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7567290 }} </ref> | ||
* | *First-line treatment for children in [[endemic]] areas is [[fluoroquinolone|fluoroquinolones]], especially in children with severe typhoid illness.<ref name="pmid8660045">{{cite journal| author=Bethell DB, Hien TT, Phi LT, Day NP, Vinh H, Duong NM et al.| title=Effects on growth of single short courses of fluoroquinolones. | journal=Arch Dis Child | year= 1996 | volume= 74 | issue= 1 | pages= 44-6 | pmid=8660045 | doi= | pmc=1511581 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8660045 }} </ref><ref name="pmid8757168">{{cite journal| author=White NJ, Dung NM, Vinh H, Bethell D, Hien TT| title=Fluoroquinolone antibiotics in children with multidrug resistant typhoid. | journal=Lancet | year= 1996 | volume= 348 | issue= 9026 | pages= 547 | pmid=8757168 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8757168 }} </ref><ref name="pmid11840084">{{cite journal| author=Stephens I, Levine MM| title=Management of typhoid fever in children. | journal=Pediatr Infect Dis J | year= 2002 | volume= 21 | issue= 2 | pages= 157-8 | pmid=11840084 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11840084 }} </ref> | ||
*Other drugs | *Other drugs that may be used for the treatment of typhoid fever in children include chlorampanicol, [[ampicillin]], and [[trimethoprim sulfamethoxazole]], depending on antibiotic susceptibility.<ref name="pmid11840084">{{cite journal| author=Stephens I, Levine MM| title=Management of typhoid fever in children. | journal=Pediatr Infect Dis J | year= 2002 | volume= 21 | issue= 2 | pages= 157-8 | pmid=11840084 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11840084 }} </ref> | ||
===Pregnancy=== | ===Pregnancy=== | ||
*Beta lactam antibiotics and fluoroquinolones are considered safe | *[[Beta-lactam antibiotic|Beta-lactam antibiotics]] and [[fluoroquinolone|fluoroquinolones]] are considered safe to use during pregnancy.<ref name="pmid105599">{{cite journal| author=Charnsangavej C| title=Occlusion of the right pulmonary artery by acute dissecting aortic aneurysm. | journal=AJR Am J Roentgenol | year= 1979 | volume= 132 | issue= 2 | pages= 274-6 | pmid=105599 | doi=10.2214/ajr.132.2.274 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=105599 }} </ref><ref>Leung, Daryl, et al. "Treatment of typhoid in pregnancy." The Lancet 346.8975 (1995): 648.</ref><ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854 }} </ref> | ||
===Chronic carrier state=== | ===Chronic carrier state=== | ||
*Fluoroquinolones may be considered | *Fluoroquinolones may be considered the ideal therapy for chronic carrier state, in which patients show antibiotic sensitivity to fluoroquinolones.<ref name="pmid1864294">{{cite journal| author=Zavala Trujillo I, Quiroz C, Gutierrez MA, Arias J, Renteria M| title=Fluoroquinolones in the treatment of typhoid fever and the carrier state. | journal=Eur J Clin Microbiol Infect Dis | year= 1991 | volume= 10 | issue= 4 | pages= 334-41 | pmid=1864294 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1864294 }} </ref> | ||
===Relapse=== | ===Relapse=== | ||
* | *Instances of relapse are treated in the same way as an initial infection.<ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854 }} </ref> | ||
* | *Optimal therapy depends on antibiotic susceptibility.<ref>Ferreccio, Catterine, et al. "Efficacy of ciprofloxacin in the treatment of chronic typhoid carriers." The Journal of infectious diseases 157.6 (1988): 1235-1239.</ref> | ||
=== Resistance === | === Resistance === | ||
*[[Antibiotics]] | *[[Antibiotics]] such as [[ampicillin]], [[chloramphenicol]], and [[trimethoprim-sulfamethoxazole]] have commonly been used to treat typhoid fever in developed countries.<ref>Herzog, Ch. "Chemotherapy of typhoid fever: a review of literature." Infection 4.3 (1976): 166-173.</ref> However, due to resistance to these antibiotics in highly [[endemic]] areas, these are no longer used as travelers have become infected with the resistant strains.<ref>White, Nicholas J., and Christopher M. Parry. "The treatment of typhoid fever." Current opinion in infectious diseases 9.5 (1996): 298-302</ref> | ||
*Typhoid that is resistant to these agents is known as [[multidrug-resistant]] typhoid (MDR typhoid).<ref name="pmid8994789[uid]">{{cite journal| author=Rowe B, Ward LR, Threlfall EJ| title=Multidrug-resistant Salmonella typhi: a worldwide epidemic. | journal=Clin Infect Dis | year= 1997 | volume= 24 Suppl 1 | issue= | pages= S106-9 | pmid=8994789[uid] | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8994789 }} </ref><ref name="pmid10819949">{{cite journal| author=Ackers ML, Puhr ND, Tauxe RV, Mintz ED| title=Laboratory-based surveillance of Salmonella serotype Typhi infections in the United States: antimicrobial resistance on the rise. | journal=JAMA | year= 2000 | volume= 283 | issue= 20 | pages= 2668-73 | pmid=10819949 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10819949 }} </ref> | *Typhoid that is resistant to these antibacterial agents is known as [[multidrug-resistant]] typhoid (MDR typhoid).<ref name="pmid8994789[uid]">{{cite journal| author=Rowe B, Ward LR, Threlfall EJ| title=Multidrug-resistant Salmonella typhi: a worldwide epidemic. | journal=Clin Infect Dis | year= 1997 | volume= 24 Suppl 1 | issue= | pages= S106-9 | pmid=8994789[uid] | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8994789 }} </ref><ref name="pmid10819949">{{cite journal| author=Ackers ML, Puhr ND, Tauxe RV, Mintz ED| title=Laboratory-based surveillance of Salmonella serotype Typhi infections in the United States: antimicrobial resistance on the rise. | journal=JAMA | year= 2000 | volume= 283 | issue= 20 | pages= 2668-73 | pmid=10819949 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10819949 }} </ref> | ||
*[[Ciprofloxacin]] resistance is an increasing problem, especially in the Indian subcontinent and Southeast Asia | *[[Ciprofloxacin]] resistance is an increasing problem, especially in the Indian subcontinent and other parts of Southeast Asia, including Pakistan, Bangladesh, Thailand, and Vietnam.<ref name="pmid11384525">{{cite journal| author=Threlfall EJ, Ward LR| title=Decreased susceptibility to ciprofloxacin in Salmonella enterica serotype typhi, United Kingdom. | journal=Emerg Infect Dis | year= 2001 | volume= 7 | issue= 3 | pages= 448-50 | pmid=11384525 | doi=10.3201/eid0703.010315 | pmc=2631792 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11384525 }} </ref> | ||
*Current recommendations for testing antibiotic susceptibility of fluoroquinolone | *Current recommendations for testing antibiotic susceptibility of fluoroquinolone indicate that isolates should be tested simultaneously against ciprofloxacin (CIP) and [[nalidixic acid]] (NAL). Isolates that are sensitive to both CIP and NAL should be reported as "sensitive to ciprofloxacin," while isolates that are sensitive to CIP but not to NAL should be reported as "reduced sensitivity to ciprofloxacin." However, an analysis of 271 isolates showed that around 18% of isolates with a reduced susceptibility to ciprofloxacin (MIC 0.125–1.0 mg/l) would not be picked up by this method.<ref>{{cite journal | title=Fluoroquinolone resistance in ''Salmonella'' Typhi (letter) | author=Cooke FJ, Wain J, Threlfall EJ | journal=Brit Med J | year=2006 | volume=333 | issue=7563 | pages=353–4 }}</ref><ref name="pmid12711825">{{cite journal| author=Asna SM, Haq JA, Rahman MM| title=Nalidixic acid-resistant Salmonella enterica serovar Typhi with decreased susceptibility to ciprofloxacin caused treatment failure: a report from Bangladesh. | journal=Jpn J Infect Dis | year= 2003 | volume= 56 | issue= 1 | pages= 32-3 | pmid=12711825 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12711825 }} </ref><ref name="pmid15380025">{{cite journal| author=Slinger R, Desjardins M, McCarthy AE, Ramotar K, Jessamine P, Guibord C et al.| title=Suboptimal clinical response to ciprofloxacin in patients with enteric fever due to Salmonella spp. with reduced fluoroquinolone susceptibility: a case series. | journal=BMC Infect Dis | year= 2004 | volume= 4 | issue= | pages= 36 | pmid=15380025 | doi=10.1186/1471-2334-4-36 | pmc=521077 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15380025 }} </ref> | ||
==Antimicrobial regimen== | ==Antimicrobial regimen== | ||
| Line 115: | Line 116: | ||
::* Alternative regimen: [[Fluoroquinolone]] 20 mg/kg/day for 7-14 days | ::* Alternative regimen: [[Fluoroquinolone]] 20 mg/kg/day for 7-14 days | ||
== References == | == References == | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Infectious diseases]] | |||
[[Category:Gastroenterology]] | |||
[[Category:FinalQCRequired]] | |||
[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
Latest revision as of 02:42, 18 July 2021
|
Typhoid fever Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Typhoid fever medical therapy On the Web |
|
American Roentgen Ray Society Images of Typhoid fever medical therapy |
|
Risk calculators and risk factors for Typhoid fever medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2], Aysha Aslam, M.B.B.S[3]
Overview
The mainstay of therapy for typhoid fever is antimicrobial therapy. Patients with uncomplicated typhoid fever are treated with either Azithromycin or a fluoroquinolone, whereas patients with severe or complicated forms of the disease are treated with either Ceftriaxone, Cefotaxime, or a fluoroquinolone.
Medical therapy
Antimicrobial therapy is recommended for all patients who develop typhoid fever. Adults and children suffering from typhoid fever require different courses of treatment.
Adults
- The mainstay of therapy in adults is the administration of fluoroquinolones due to rapid response rate.[1][2][3][4]
- Other agents used due to emerging resistance to fluoroquinolones are third-generation cephalosorins and Azithromycin.
Fluoroquinolones
- Mainstay of therapy in regions which demonstrates antibiotic susceptiblity to fluoroquinolones[5]
- Bactericidial; concentrates intracellularly and in bile
- Early defervescence (less than 4 days)[6]
- Cure rate of 96 percent
- Relapse and carrier state of less than 2 percent[7][8]
Third-generation cephalosporins
- First-line agent in adults with fluoroquinolone resistance[9]
- Main agents include ceftriaxone, cefixime, cefotaxime, and cefoperazone[10][11]
- Defervescence averages one week[5]
- Cure rate of 95 percent
- Relapse and carrier rate of less than 3 percent
Azithromycin
- First-line agent in adults with fluoroquinolone or third-generation cephalsporin resistance[12][13]
- Excellent intracellular concentration[14][15]
- Defervescence of 4 to 6 days[5]
- Cure rate of 95 percent[16]
- Relapse and carrier rate of less than 3 percent
Children
- The mainstay of therapy for children in United States is third-generation cephaloporins due to suspected skeletal and tendinous side effects of fluoroquinolones in children.[17][18][19][20]
- First-line treatment for children in endemic areas is fluoroquinolones, especially in children with severe typhoid illness.[21][22][23]
- Other drugs that may be used for the treatment of typhoid fever in children include chlorampanicol, ampicillin, and trimethoprim sulfamethoxazole, depending on antibiotic susceptibility.[23]
Pregnancy
- Beta-lactam antibiotics and fluoroquinolones are considered safe to use during pregnancy.[24][25][5]
Chronic carrier state
- Fluoroquinolones may be considered the ideal therapy for chronic carrier state, in which patients show antibiotic sensitivity to fluoroquinolones.[26]
Relapse
- Instances of relapse are treated in the same way as an initial infection.[5]
- Optimal therapy depends on antibiotic susceptibility.[27]
Resistance
- Antibiotics such as ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole have commonly been used to treat typhoid fever in developed countries.[28] However, due to resistance to these antibiotics in highly endemic areas, these are no longer used as travelers have become infected with the resistant strains.[29]
- Typhoid that is resistant to these antibacterial agents is known as multidrug-resistant typhoid (MDR typhoid).[30][31]
- Ciprofloxacin resistance is an increasing problem, especially in the Indian subcontinent and other parts of Southeast Asia, including Pakistan, Bangladesh, Thailand, and Vietnam.[32]
- Current recommendations for testing antibiotic susceptibility of fluoroquinolone indicate that isolates should be tested simultaneously against ciprofloxacin (CIP) and nalidixic acid (NAL). Isolates that are sensitive to both CIP and NAL should be reported as "sensitive to ciprofloxacin," while isolates that are sensitive to CIP but not to NAL should be reported as "reduced sensitivity to ciprofloxacin." However, an analysis of 271 isolates showed that around 18% of isolates with a reduced susceptibility to ciprofloxacin (MIC 0.125–1.0 mg/l) would not be picked up by this method.[33][34][35]
Antimicrobial regimen
- Typhoid fever[36]
- Uncomplicated typhoid
- Preferred regimen (1) (fully susceptible): Fluoroquinolone (e.g., Ofloxacin 15 mg/kg PO qd for 5–7 days)
- Preferred regimen (2) (multi drug-resistant): Fluoroquinolone (Ofloxacin 15 mg/kg PO qd for 5–7 days)
- Preferred regimen (3) (quinolone-resistant): Azithromycin 8–10 mg/kg PO qd for 7 days
- Preferred regimen (4) (quinolone-resistant): Fluoroquinolone 20 mg/kg PO qd for 10-14 days
- Alternative regimen (1) (fully susceptible): Chloramphenicol 50–75 mg/kg PO qd for 14-21 days
- Alternative regimen (2) (fully susceptible): Amoxicillin 75–100 mg/kg PO qd for 14 days
- Alternative regimen (3) (fully susceptible): Trimethoprim–Sulfamethoxazole, 8 mg/kg (trimethoprim)– 40 mg/kg (sulfamethoxazole) PO qd for 14 days
- Alternative regimen (4) (multi drug-resistant): Azithromycin 8–10 mg/kg PO for 7 days
- Alternative regimen (5) (multi drug-resistant): Third-generation cephalosporin, e.g., Cefixime 20 mg/kg PO qd for 7-14 days
- Alternative regimen (6) (quinolone-resistant): Third-generation cephalosporin, e.g., Cefixime 20 mg/kg PO qd for 7-14 days
- Severe typhoid
- Preferred regimen (1) (fully susceptible): Fluoroquinolone (e.g., Ofloxacin 15 mg/kg IV qd for 10-14 days)
- Preferred regimen (2) (multi drug-resistant): Fluoroquinolone (Ofloxacin 15 mg/kg IV qd for 10-14 days)
- Preferred regimen (3) (quinolone-resistant): Ceftriaxone 60 mg/kg IV qd for 10-14 days
- Preferred regimen (4) (quinolone-resistant): Cefotaxime 80 mg/kg IV qd for 10-14 days
- Alternative regimen (1) (fully susceptible): Chloramphenicol 100 mg/kg PO qd for 14-21 days
- Alternative regimen (2) (fully susceptible): Ampicillin 100 mg/kg PO qd for 14-21 days
- Alternative regimen (3) (fully susceptible): Trimethoprim–Sulfamethoxazole, 8 mg/kg (trimethoprim)– 40 mg/kg (sulfamethoxazole) IV qd for 10-14 days
- Alternative regimen (4) (multi drug-resistant): Ceftriaxone 60 mg/kg IV qd for 10-14 days
- Alternative regimen (5) (multi drug-resistant): Cefotaxime 80 mg/kg IV qd for 10-14 days
- Alternative regimen (6) (quinolone-resistant): Fluoroquinolone 20 mg/kg IV qd for 10-14 days
- 1. Uncomplicated typhoid fever[37]
- 1.1 Fully sensitive
- Preferred regimen (1): Ofloxacin 15 mg/kg/day for 5-7 days
- Preferred regimen (2): Ciprofloxacin 15 mg/kg/day for 5-7 days
- Alternative regimen (1): Chloramphenicol 50-75 mg/kg/day for 14-21 days
- Alternative regimen (2): Amoxicillin 75-100 mg/kg/day for 14 days
- Alternative regimen (3): TMP-SMX 8-40 mg/kg/day for 14 days
- 1.2 Multidrug resistance
- Preferred regimen (1): Fluoroquinolone 15 mg/kg/day for 5-7 days
- Preferred regimen (2): Cefixime 15-20 mg/kg/day for 7-14 days
- Alternative regimen (1): Azithromycin 8-10 mg/kg/day for 7 days
- Alternative regimen (2): Cefixime 15-20 mg/kg/day for 7-14 days
- 1.3 Quinolone resistance
- Preferred regimen (1): Azithromycin 8-10 mg/kg/day for 7 days
- Preferred regimen (2): Ceftriaxone 75 mg/kg/day for 10-14 days
- Alternative regimen: Cefixime 20 mg/kg/day for 7-14 days
- 2. Severe typhoid fever
- 2.1 Fully sensitive
- Preferred regimen: Ofloxacin 15 mg/kg/day for 10-14 days
- Alternative regimen (1): Chloramphenicol 100 mg/kg/day for 14-21 days
- Alternative regimen (2): Amoxicillin 100 mg/kg/day for 14 days
- Alternative regimen (3): TMP-SMX 8-40 mg/kg/day for 14 days
- 2.2 Multidrug resistant
- Preferred regimen: Fluoroquinolone 15 mg/kg/day for 10-14 days
- Alternative regimen (1): Ceftriaxone 60 mg/kg/day for 10-14 days
- Alternative regimen (2): Cefotaxime 80 mg/kg/day for 10-14 days
- 2.3 Quinolone resistant
- Preferred regimen (1): Ceftriaxone 60 mg/kg/day for 10-14 days
- Preferred regimen (2): Cefotaxime 80 mg/kg/day for 10-14 days
- Alternative regimen: Fluoroquinolone 20 mg/kg/day for 7-14 days
References
- ↑ Gotuzzo, Eduardo, and Carlos Carrillo. "Quinolones in typhoid fever." Infectious Diseases in Clinical Practice 3.5 (1994): 345-351.
- ↑ White, Nicholas J., and Christopher M. Parry. "The treatment of typhoid fever." Current opinion in infectious disases 9.5 (1996): 298-302
- ↑ Cao XT, Kneen R, Nguyen TA, Truong DL, White NJ, Parry CM (1999). "A comparative study of ofloxacin and cefixime for treatment of typhoid fever in children. The Dong Nai Pediatric Center Typhoid Study Group". Pediatr Infect Dis J. 18 (3): 245–8. PMID 10093945.
- ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID http://dx.doi.org/10.1016/S0140-6736(13)62708-7 Check
|pmid=value (help). - ↑ 5.0 5.1 5.2 5.3 5.4 Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ (2002). "Typhoid fever". N Engl J Med. 347 (22): 1770–82. doi:10.1056/NEJMra020201. PMID 12456854.
- ↑ Smith MD, Duong NM, Hoa NT, Wain J, Ha HD, Diep TS; et al. (1994). "Comparison of ofloxacin and ceftriaxone for short-course treatment of enteric fever". Antimicrob Agents Chemother. 38 (8): 1716–20. PMC 284627. PMID 7986000.
- ↑ Thaver D, Zaidi AK, Critchley J, Azmatullah A, Madni SA, Bhutta ZA (2009). "A comparison of fluoroquinolones versus other antibiotics for treating enteric fever: meta-analysis". BMJ. 338: b1865. doi:10.1136/bmj.b1865. PMC 2690620. PMID 19493939.
- ↑ Girgis, Nabil I., et al. "Azithromycin versus ciprofloxacin for treatment of uncomplicated typhoid fever in a randomized trial in Egypt that included patients with multidrug resistance." Antimicrobial agents and chemotherapy 43.6 (1999): 1441-1444.
- ↑ Parry CM (2004). "The treatment of multidrug-resistant and nalidixic acid-resistant typhoid fever in Viet Nam". Trans R Soc Trop Med Hyg. 98 (7): 413–22. doi:10.1016/j.trstmh.2003.10.014. PMID 15138078.
- ↑ Rastegar Lari A, Validi N, Ghaffarzadeh K, Shamshiri AR (1997). "In vitro activity of cefixime versus ceftizoxime against Salmonella typhi". Pathol Biol (Paris). 45 (5): 415–9. PMID 9296095.
- ↑ White, Nicholas J., and Christopher M. Parry. "The treatment of typhoid fever." Current opinion in infectious diseases 9.5 (1996): 298-302.
- ↑ Dolecek C, Tran TP, Nguyen NR, Le TP, Ha V, Phung QT; et al. (2008). "A multi-center randomised controlled trial of gatifloxacin versus azithromycin for the treatment of uncomplicated typhoid fever in children and adults in Vietnam". PLoS One. 3 (5): e2188. doi:10.1371/journal.pone.0002188. PMC 2374894. PMID 18493312.
- ↑ Meltzer E, Stienlauf S, Leshem E, Sidi Y, Schwartz E (2014). "A large outbreak of Salmonella Paratyphi A infection among israeli travelers to Nepal". Clin Infect Dis. 58 (3): 359–64. doi:10.1093/cid/cit723. PMID 24198224.
- ↑ Panteix G, Guillaumond B, Harf R, Desbos A, Sapin V, Leclercq M; et al. (1993). "In-vitro concentration of azithromycin in human phagocytic cells". J Antimicrob Chemother. 31 Suppl E: 1–4. PMID 8396080.
- ↑ Chinh, Nguyen Tran, et al. "A randomized controlled comparison of azithromycin and ofloxacin for treatment of multidrug-resistant or nalidixic acid-resistant enteric fever." Antimicrobial agents and chemotherapy 44.7 (2000): 1855-1859.
- ↑ Butler, Thomas, et al. "Treatment of typhoid fever with azithromycin versus chloramphenicol in a randomized multicentre trial in India." Journal of Antimicrobial Chemotherapy 44.2 (1999): 243-250.
- ↑ Burkhardt JE, Walterspiel JN, Schaad UB (1997). "Quinolone arthropathy in animals versus children". Clin Infect Dis. 25 (5): 1196–204. PMID 9402381.
- ↑ Phuong, Cao Xuan Thanh, et al. "A comparative study of ofloxacin and cefixime for treatment of typhoid fever in children." The Pediatric infectious disease journal 18.3 (1999): 245-248.
- ↑ Memon, IQBAL AHMAD, Abdul Gaffar Billoo, and HAMIDA IQBAL Memon. "Cefixime: an oral option for the treatment of multidrug-resistant enteric fever in children." Southern medical journal 90.12 (1997): 1204-1207.
- ↑ Girgis NI, Sultan Y, Hammad O, Farid Z (1995). "Comparison of the efficacy, safety and cost of cefixime, ceftriaxone and aztreonam in the treatment of multidrug-resistant Salmonella typhi septicemia in children". Pediatr Infect Dis J. 14 (7): 603–5. PMID 7567290.
- ↑ Bethell DB, Hien TT, Phi LT, Day NP, Vinh H, Duong NM; et al. (1996). "Effects on growth of single short courses of fluoroquinolones". Arch Dis Child. 74 (1): 44–6. PMC 1511581. PMID 8660045.
- ↑ White NJ, Dung NM, Vinh H, Bethell D, Hien TT (1996). "Fluoroquinolone antibiotics in children with multidrug resistant typhoid". Lancet. 348 (9026): 547. PMID 8757168.
- ↑ 23.0 23.1 Stephens I, Levine MM (2002). "Management of typhoid fever in children". Pediatr Infect Dis J. 21 (2): 157–8. PMID 11840084.
- ↑ Charnsangavej C (1979). "Occlusion of the right pulmonary artery by acute dissecting aortic aneurysm". AJR Am J Roentgenol. 132 (2): 274–6. doi:10.2214/ajr.132.2.274. PMID 105599.
- ↑ Leung, Daryl, et al. "Treatment of typhoid in pregnancy." The Lancet 346.8975 (1995): 648.
- ↑ Zavala Trujillo I, Quiroz C, Gutierrez MA, Arias J, Renteria M (1991). "Fluoroquinolones in the treatment of typhoid fever and the carrier state". Eur J Clin Microbiol Infect Dis. 10 (4): 334–41. PMID 1864294.
- ↑ Ferreccio, Catterine, et al. "Efficacy of ciprofloxacin in the treatment of chronic typhoid carriers." The Journal of infectious diseases 157.6 (1988): 1235-1239.
- ↑ Herzog, Ch. "Chemotherapy of typhoid fever: a review of literature." Infection 4.3 (1976): 166-173.
- ↑ White, Nicholas J., and Christopher M. Parry. "The treatment of typhoid fever." Current opinion in infectious diseases 9.5 (1996): 298-302
- ↑ Rowe B, Ward LR, Threlfall EJ (1997). "Multidrug-resistant Salmonella typhi: a worldwide epidemic". Clin Infect Dis. 24 Suppl 1: S106–9. PMID [uid 8994789[uid]] Check
|pmid=value (help). - ↑ Ackers ML, Puhr ND, Tauxe RV, Mintz ED (2000). "Laboratory-based surveillance of Salmonella serotype Typhi infections in the United States: antimicrobial resistance on the rise". JAMA. 283 (20): 2668–73. PMID 10819949.
- ↑ Threlfall EJ, Ward LR (2001). "Decreased susceptibility to ciprofloxacin in Salmonella enterica serotype typhi, United Kingdom". Emerg Infect Dis. 7 (3): 448–50. doi:10.3201/eid0703.010315. PMC 2631792. PMID 11384525.
- ↑ Cooke FJ, Wain J, Threlfall EJ (2006). "Fluoroquinolone resistance in Salmonella Typhi (letter)". Brit Med J. 333 (7563): 353&ndash, 4.
- ↑ Asna SM, Haq JA, Rahman MM (2003). "Nalidixic acid-resistant Salmonella enterica serovar Typhi with decreased susceptibility to ciprofloxacin caused treatment failure: a report from Bangladesh". Jpn J Infect Dis. 56 (1): 32–3. PMID 12711825.
- ↑ Slinger R, Desjardins M, McCarthy AE, Ramotar K, Jessamine P, Guibord C; et al. (2004). "Suboptimal clinical response to ciprofloxacin in patients with enteric fever due to Salmonella spp. with reduced fluoroquinolone susceptibility: a case series". BMC Infect Dis. 4: 36. doi:10.1186/1471-2334-4-36. PMC 521077. PMID 15380025.
- ↑ "TYPHOID FEVER".
- ↑ "The diagnosis, treatment and prevention of typhoid fever" (PDF).