Quinolones are the drug of choice according to latest Cochrane review. The prevalence of nalidixic acid resistance (NAR) in Indian sub-continant is quite high. We face clinical resistance to quinolones when treating enteric fever, therefore would like to learn from others.
In view of the fact that majority (> 90%) of the S. Typhi Indian isolates showing decreased susceptibility to ciprofloxacin with higher MIC of ciprofloxacin (>0.125 ug/ml), this drug should not be used for typhoid treatment. Rather oral cephalosporin (cefixime) may be a better choice and in resistant cases injectable ceftriaxone may be used for typhoid.
The drug of choice for enteric fever due to Salmonella typhi is ceftriazone.
The drug of choice for enteric fever due to Salmonella typhi is ceftriaxone which have to be administered by IV. Therefore it can only be prescribed to patients who are warded. For patients who are not warded, the oral cephalosporin is an alternative in the empirical treatment.
If S.typhi proved to be resistant to ciprofloxacin I would recommend the use of chloramphenicol since this old drug is still one of the best available drugs which can cure the patient quickly, has actually rarely side effects and it is very cheap drug.
Cloramfenicol beyond any doubt! Always think to restore old drugs and be very aware ofESBLs especially if it is possible to coexist with FQs resistance.
Please colleagues don't forget that old useful drugs like chloramphenicol have been pushed away from clinical use by big pharmaceutical companies rather than medical experience or due to high side effects.
Why should we use Ciproxine or 3 rd generation as first choice, we still go for amoxiccilin or augmentin in high doses until we get the culture and i works nicely
Moreover, if you treat empirically, always think of bacteriostatic antibiotics as well, if the patient is not neutropenic.
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