Ceftriaxone Treatment for Typhoid Fever

First-line Treatment Options

The British Journal of Pharmacology recommends a dose of 50-80 mg/kg/day (maximum 2g/day) intravenously or intramuscularly for 5-7 days for patients with fever and a positive typhoid test 1, 2
Ceftriaxone is an appropriate first-line parenteral therapy for typhoid fever, particularly in areas with high fluoroquinolone resistance 3, 2
For adults, a standard dose of 1-2g daily is recommended, while children should receive 50-80 mg/kg/day 1
Treatment duration should typically be 5-7 days, though this may be extended in complicated cases 1

Adults should receive 1-2g IV/IM daily for 5-7 days 3, 2
Children should receive 50-80 mg/kg/day IV/IM (maximum 2g/day) for 5-7 days 1
Neonates: 50 mg/kg/day given every 24 hours, though typhoid fever is rare in this age group 4

For severe cases requiring hospitalization, initial intravenous administration is preferred 3, 2
Once clinical improvement occurs, transition to oral therapy (such as azithromycin) may be considered 2, 5

In areas with high fluoroquinolone resistance, azithromycin (20 mg/kg/day, maximum 1g/day) for 7 days is another recommended first-line option 2, 5
For fully susceptible strains, fluoroquinolones remain effective alternatives 2, 5
In severe cases, adding steroids may be helpful 3

Always obtain blood cultures before starting antibiotics when possible, as they have the highest yield within the first week of symptom onset 3, 5
Be aware that over 70% of S. typhi and S. paratyphi isolates imported into the UK are resistant to fluoroquinolones, making ceftriaxone or azithromycin better empiric choices 3
Relapse rates with ceftriaxone are generally lower (<8%) compared to some other treatments 3

For pregnant patients, ceftriaxone is generally considered safe and effective 2
For patients with severe hepatic or renal impairment, dose adjustments may be necessary 2