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What Should We Be Recommending for the Treatment of Enteric Fever?

Published version
Peer-reviewed

Repository DOI


Type

Article

Change log

Authors

Parry, Christopher M  ORCID logo  https://orcid.org/0000-0001-7563-7282
Qamar, Farah N 
Rijal, Samita 
McCann, Naina 
Baker, Stephen 

Abstract

Patients with suspected enteric (typhoid and paratyphoid) fever are predominantly managed as outpatients in endemic regions. Nonspecific clinical presentation, lack of accurate diagnostic tools, and widespread antimicrobial resistance makes management challenging. Resistance has been described for all antimicrobials including chloramphenicol, amoxycillin, trimethoprim-sulfamethoxazole, ciprofloxacin, ceftriaxone, and azithromycin. No significant differences have been demonstrated between these antimicrobials in their ability to treat enteric fever in systematic reviews of randomized controlled trials (RCTs). Antimicrobial choice should be guided by local resistance patterns and national guidance. Extensively drug-resistant typhoid isolates require treatment with azithromycin and/or meropenem. Combining antimicrobials that target intracellular and extracellular typhoid bacteria is a strategy being explored in the Azithromycin and Cefixime in Typhoid Fever (ACT-SA) RCT, in progress in South Asia. Alternative antimicrobials, such as the oral carbapenem, tebipenem, need clinical evaluation. There is a paucity of evidence to guide the antimicrobial management of chronic fecal carriers.

Description

Keywords

RCTs, XDR typhoid, antimicrobial resistance, enteric fever, systematic reviews

Journal Title

Open Forum Infect Dis

Conference Name

Journal ISSN

2328-8957
2328-8957

Volume Title

10

Publisher

Oxford University Press (OUP)