Treatment of Enteric Fever

Initial Management

For patients with enteric fever, empiric treatment with a fluoroquinolone or azithromycin should be initiated after blood, stool, and urine culture collection, with therapy adjusted based on antimicrobial susceptibility testing results 1, 2, 3
Patients with clinical features of sepsis who are suspected of having enteric fever should receive empiric broad-spectrum antimicrobial therapy after appropriate cultures are collected 2, 4
Antimicrobial therapy should be narrowed when susceptibility testing results become available 4
If culture results are unavailable, antimicrobial choice should be tailored to susceptibility patterns from the setting where acquisition occurred 4

Fluoroquinolones, such as ciprofloxacin 500 mg twice daily for 7-10 days or ofloxacin 400 mg twice daily for 7-10 days, are effective treatment options 3
Azithromycin is considered as first-line therapy in areas with known fluoroquinolone resistance 5, 3
Azithromycin has a lower risk of clinical failure and shorter hospital stay compared to fluoroquinolones in some studies 3
Third-generation cephalosporins, such as ceftriaxone or cefixime, are second-line options when resistance to first-line agents is suspected 3, 6

Local susceptibility patterns should guide therapy choice 4, 3
Travel history should be considered when selecting empiric therapy 4, 5
Asymptomatic contacts of people with enteric fever should not be offered empiric treatment but should follow appropriate infection prevention and control measures 4

Reassessment of fluid and electrolyte balance, nutritional status, and optimal dose and duration of antimicrobial therapy is recommended in people with persistent symptoms 7
Reduced osmolarity oral rehydration solution (ORS) is recommended as first-line therapy for mild to moderate dehydration 8
For severe dehydration, shock, or altered mental status, isotonic intravenous fluids should be administered 8