WHO‑Recommended Treatment Hierarchy for Typhoid Fever

Fully Susceptible Salmonella Typhi Strains

• The World Health Organization (WHO) recommends fluoroquinolones (ciprofloxacin, gatifloxacin, ofloxacin) as the first‑line oral therapy for infections caused by fully susceptible strains【1】【2】.
• WHO lists chloramphenicol, amoxicillin, or trimethoprim‑sulfamethoxazole as alternative oral agents when fluoroquinolones cannot be used【2】.

Quinolone‑Resistant Salmonella Typhi Strains

• For strains resistant to fluoroquinolones, WHO recommends azithromycin or ceftriaxone as the preferred treatment options【2】【3】.
• Clinical evidence shows that azithromycin results in a lower rate of treatment failure compared with fluoroquinolones (odds ratio 0.48; 95 % CI 0.26‑0.89)【1】.
• Azithromycin also yields a substantially lower relapse rate than ceftriaxone (odds ratio 0.09; 95 % CI 0.01‑0.70)【2】.