Children younger than 1 year with drug-susceptible typhoid or paratyphoid fever

In children younger than 1 year with drug-susceptible (not extensively drug-resistant) typhoid or paratyphoid fever, if susceptibility is confirmed, useNabarro, 2022Wen, 2017:

1azithromycin 20 mg/kg intravenously, as a single dose on day 1, followed by 10 mg/kg intravenously, daily1. See advice on duration of therapy azithromycin

OR

1cefotaxime 50 mg/kg intravenously, 6-hourly. See advice in duration of therapy cefotaxime

OR

1ceftriaxone (child 1 month or older) 100 mg/kg intravenously, daily. See advice on duration of therapy ceftriaxone

OR

1ciprofloxacin 10 mg/kg intravenously, 12-hourly23. See advice on duration of therapy. ciprofloxacin

For neonates with typhoid or paratyphoid fever, seek expert advice.

For children younger than 1 year who have had a nonsevere (immediate or delayed) or severe immediate4 hypersensitivity reaction to a penicillin, depending on susceptibility results any of the above regimens can be used.

For children younger than 1 year who have had a severe delayed5 hypersensitivity reaction to a penicillin, depending on susceptibility results, 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