3.2 Enteric fever
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Uncomplicated - Can be treated at OPDs (if without complications such as severe dehydration, weakness, abdominal haemorrhage, encephalitis) | Azithromycin 20 mg /kg/ day for 7 days (maximum 1g/day) Or Cotrimoxazole 960 mg BD for 2 weeks (10 mg/kg of TMP) | Cefixime 20mg/kg/day for 10-14 days | Blood culture remains the gold standard. Avoid using Widal test for diagnosis of Enteric fever. Resistance rates are low for co-trimoxazole, chloramphenicol and third generation cephalosporins. Empirical use of fluoroquinolones should be avoided. Defervescence of fever may take up to 4-5 days; so mere persistent fever for 4-5 days should not be the reason to switch antibiotics. Cefixime has been associated with longer time to defervescence compared to other antibiotic classes. |
| Complicated - persistent high fever or any of the complications mentioned above | Ceftriaxone 2g IV OD for 10- 14 days and / Or Azithromycin 20mg/kg/ day for 7 days for Inpatients | Follow up with culture susceptibility to modify and plan oral switch. Ceftriaxone can be changed to oral cefixime/ cotrimoxazole, when patient improves to complete total duration of 10- 14 days.Empiric use of carbapenems should be avoided. |
For common etiological agents of Enteric fever, see Annexure B.3.2
References
1. Kuehn R, Stoesser N, Eyre D, Darton TC, Basnyat B, Parry CM. Treatment of enteric fever (typhoid and paratyphoid fever) with cephalosporins. Cochrane Database Syst Rev. 2022;11(11):CD010452. Published 2022 Nov 24. doi:10.1002/14651858.CD010452.pub2
2. Treatment Guidelines for Antimicrobial Use in Common Syndromes. 2nd edition. ICMR. 2019. New Delhi (Accessed on 2nd April, 2025). Available from: https://www.icmr.gov.in/icmrobject/custom_data/pdf/resource-guidelines/Treatment_Guidelines_2019_Final.pdf