Typhoid fever

Salmonella Typhi arrives with water or food, crosses the gut wall and spreads through lymphoid tissue. Fever climbs in steps over a week, joined by headache, abdominal pain, splenomegaly and rose spots. Stool is more often held back than loose, which sets typhoid apart from ordinary gut infection. Untreated, the third week brings intestinal bleeding and perforation. In Europe the disease is imported: nearly every Spanish case follows travel.

ICD-10 A01.01 drug

Also known as: Enteric fever, Salmonella Typhi infection

Drugs used for this condition

BChloramphenicolThird line · Amphenicol antibiotic for systemic useChloramphenicol was the first antibiotic that cured typhoid fever, and the FDA label still keeps acute Salmonella Typhi infection as the opening line of its indications. In Europe today typhoid is treated with ceftriaxone or azithromycin: they act faster and put no threat on the marrow. Chloramphenicol remains an option for regions where strains resistant to fluoroquinolones and cephalosporins circulate and nothing else is at hand. The same label states that in typhoid, therapeutic levels are maintained for 8 to 10 days after the patient becomes afebrile, to lessen the chance of relapse. The S. Typhi carrier state is not treated with chloramphenicol. Spain has no systemic chloramphenicol: CIMA lists only an eye ointment and a cutaneous form.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit