Table 1.

Antimicrobial treatment options for enteric fever^{10 29 30 31}

Susceptibility*	First-line treatment				Alternative treatment
	Antimicrobial	Total daily dose (mg/kg)	Duration (days)		Antimicrobial	Total daily dose (mg/kg)	Duration (days)
Uncomplicated enteric fever
Unkown susceptibility*	Azithromycin	20	7		—
Fully susceptible	Ciprofloxacin†	20	7		Chloramphenicol‡	50-75	14
					Amoxicillin	75-100	14
					TMP-SMX§	8-40¶	14
					Cefixime	20	7-14
Multidrug resistant**	Ciprofloxacin†	20	7		Cefixime	20	7-14
					Azithromycin	20	7
Quinolone resistant††	Azithromycin	20	7		—
Extensively drug resistant‡‡	Azithromycin	20	7		—
Severe enteric fever requiring parenteral treatment §§
Unkown susceptibilty*	Ceftriaxone	50-75	10-14
Fully susceptible	Ciprofloxacin†	20	10-14		Ceftriaxone	50-75	10-14
Multidrug resistant**	Ciprofloxacin†	20	10-14		Ceftriaxone	50-75	10-14
Quinolone resistant††	Ceftriaxone	50-75	10-14		Azithromycin	20	10-14
Extensively drug resistant‡‡	Meropenem	60	10-14		Azithromycin	20	10-14
Regimens proposed for eradication of chronic carriage (dependent on susceptibility of the isolate)
Amoxycilllin susceptible	Ampicillin	100	90		—
	Amoxycillin with probenecid	30
TMP-SMX§ susceptible	TMP-SMX§	8-40¶	90		—
Ciprofloxacin susceptible	Ciprofloaxacin	20	28		—

^*Culture and susceptibility results often unavailable. Empirical treatment should be based on regional knowledge of susceptibility patterns.

^†Ofloxacin and levofloxacin are effective alternatives.

^‡Chloramphenicol may cause bone marrow suppression; oral route preferred.

^§TMP-SMX = trimethoprim-sulphamethoxazole. Inexpensive; may cause allergic reactions and nephrotoxicity, not suitable for children <2 years old or during pregnancy.

^¶8 mg/kg trimethoprim–40 mg/kg sulphamethoxazole.

^**Multidrug resistant: resistant to chloramphenicol, amoxycillin, trimethoprim-sulphamethoxazole

^††Quinolone resistant: non-susceptible to ciprofloxacin (pefloxacin resistant/ciprofloxacin resistant by disk testing)

^‡‡Extensively drug resistant: resistant to chloramphenicol, amoxycillin, trimethoprim-sulphamethoxazole, ciprofloxacin, and ceftriaxone

^§§In severe enteric fever (characterised by delirium, obtundation, coma, or shock) dexamethasone may be beneficial (dose 3 mg/kg infused intravenously over 30 min, followed by 8 doses of 1 mg/kg every 6  hours). In severe enteric fever with intestinal perforation and peritonitis, a laparotomy is recommended to identify and close the perforation(s) and to perform cleaning of the peritoneal cavity.