Adults and children 1 year and older with drug-susceptible typhoid or paratyphoid fever

In adults and children 1 year and older with drug-susceptible (not extensively drug-resistant) typhoid or paratyphoid fever, if susceptibility is confirmed and oral therapy is appropriate, useNabarro, 2022Wen, 2017:

1azithromycin 1 g (child: 20 mg/kg up to 1 g) orally, as a single dose on day 1, followed by 500 mg (child 10 mg/kg up to 500 mg) daily1. See advice on duration of therapy azithromycin azithromycin azithromycin

OR

1ciprofloxacin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 12-hourly23. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment. See advice on duration of therapy. ciprofloxacin ciprofloxacin ciprofloxacin

In adults and children 1 year or older with drug-susceptible (not extensively drug-resistant) typhoid or paratyphoid fever, if susceptibility is confirmed and intravenous therapy is required, useNabarro, 2022Wen, 2017:

1azithromycin 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, daily1. See advice on duration of therapy azithromycin azithromycin azithromycin

OR

1cefotaxime 2 g (child 1 year or older: 50 mg/kg up to 2 g) intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see cefotaxime dosage adjustment. See advice on duration of therapy cefotaxime cefotaxime cefotaxime

OR

1ceftriaxone 2 g (child 1 year or older: 100 mg/kg up to 2 g) intravenously, daily. See advice on duration of therapy ceftriaxone ceftriaxone ceftriaxone

OR

1ciprofloxacin 400 mg (child: 10 mg/kg up to 400 mg) intravenously, 12-hourly. For dosage adjustment in adults with kidney impairment, see ciprofloxacin intravenous dosage adjustment. See advice on duration of therapy2. ciprofloxacin ciprofloxacin ciprofloxacin

For adults and children requiring intravenous therapy who have had a nonsevere (immediate or delayed) or severe immediate4 hypersensitivity reaction to a penicillin, depending on the susceptibility results, any of the above intravenous regimens can be used.

For patients requiring intravenous therapy who have had a severe delayed5 hypersensitivity reaction to a penicillin, depending on the results of susceptibility, use azithromycin or ciprofloxacin (see dosages above). If susceptibility has not been reported for azithromycin or ciprofloxacin, seek expert advice.

1 If azithromycin is the drug of choice but susceptibility has not been reported, discuss with a clinical microbiologist as azithromycin may be appropriate.Return
2 Ciprofloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, clinical trial data suggest that adverse musculoskeletal events are usually mild and short term, similar to those observed in adults. Ciprofloxacin can be used in children when it is the drug of choice.Return
3 An oral liquid formulation of ciprofloxacin is not commercially available; for formulation options for children or people with swallowing difficulties, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return
4 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return
5 Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return