Patients without sepsis or septic shock who have not recently returned from Pakistan
For initial therapy for adults and children with typhoid or paratyphoid fever who require hospital admission or are unable to tolerate oral therapy, do not have sepsis or septic shock and have not recently returned from Pakistan1, useNabarro, 2022Wen, 2017:
1ceftriaxone 2 g (child 1 month or older: 100 mg/kg up to 2 g) intravenously, daily. Modify antibiotic choice once susceptibility results are available; see Directed therapy for acute typhoid or paratyphoid fever ceftriaxone ceftriaxone ceftriaxone
OR
1cefotaxime 2 g (child: 50 mg/kg up to 2 g) intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see cefotaxime dosage adjustment. Modify antibiotic choice once susceptibility results are available; see Directed therapy for acute typhoid or paratyphoid fever cefotaxime cefotaxime cefotaxime
OR
2azithromycin 1 g (child: 20 mg/kg up to 1 g) intravenously, as a single dose on day 1, followed by 500 mg (child: 10 mg/kg up to 500 mg) intravenously, daily. Modify antibiotic choice once susceptibility results are available; see Directed therapy for acute typhoid or paratyphoid fever. azithromycin azithromycin azithromycin
Ceftriaxone and cefotaxime are preferred to azithromycin for empirical therapy because they have a broader spectrum of activity and provide effective treatment for other potential pathogens. This is particularly important for patients treated on the basis of their clinical presentation in whom Salmonella has not been isolated.
For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, any of the above regimens can be used.
For patients who have had a severe immediate2 hypersensitivity reaction to a penicillin, ceftriaxone or cefotaxime (at the dosages above) can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).
For patients who have had a severe immediate2 hypersensitivity reaction to a penicillin in whom ceftriaxone or cefotaxime is not used, or for patients who have had a severe (delayed)3 hypersensitivity reaction to a penicillin, use azithromycin (see dosage above).