Enteric fever

Meaning typhoid and paratyphoid infection.

Typhus means smoke, refers to clouded consciousness characteristic of typhus and typhoid.

S. paratyphi treated the same but milder.

Pretty non-specific presentations – although called enteric, not striking vomiting/diarrhoea, in fact can be constipated…

3 sets of blood cultures and stool cultures!


  • GI bleeding and perforation
  • Cholecystitis
  • Myocarditis


Always treat, even if well and only from stool (cf other salmonella types).

IV ceftriaxone if unwell or blood culture positive. Else azithromycin.

Normal for fever to persist for 10 days despite treatment.

Drug resistance is a big problem. Fluoroquinolones preferred, oral third generation cephalosporins are also effective although inferior in RCTs. Azithromycin is also effective although response possibly slower. Quinolone resistance so far confined largely to Central Asia, India and Vietnam.

Where nalidixic acid resistant, in vitro susceptibility to quinolones definitely reduced – use of maximum permitted doses and extending treatment course to 10-14 days will result in cure in >90% of cases — although the clinical response is slower.

Lots of data on quinolone use in children, so despite theoretical risks still preferred.