The treatment of typhoid fever

Strains of Salmonella typhi which are resistant to the three first-line antibiotics, chloramphenicol, trimethoprim-sulphamethoxazole and amoxycillin, are increasingly prevalent in tropical countries. These strains retain sensitivity both to the fluoroquinolones and to the third-generation cephalosporins in vitro, although therapeutic responses following fluoroquinolone treatment are superior. In studies involving over 300 adults and children in Viet Nam with uncomplicated multidrug-resistant typhoid fever treatment, 3–5 day courses of oral ofloxacin or fleroxacin gave cure rates of between 96 and 100% and were well tolerated. A short course of fluoroquinolones may become the treatment of choice for enteric fever in areas where multidrug-resistant strains of S. typhi are prevalent.