Typhoid Fever Pharmacotherapy

Introduction

• Enteric (typhoid) fever is a systemic febrile illness caused by the human-restricted invasive serovars of Salmonella enterica — S. Typhi (typhoid) and S. Paratyphi A/B/C (paratyphoid) — distinct from the self-limiting gastroenteritis of nontyphoidal Salmonella.
• The organism is a facultative intracellular Gram-negative bacillus; disease reflects bacteraemic dissemination and survival within reticuloendothelial macrophages, so effective drugs must achieve good intracellular and biliary concentrations, not merely luminal gut levels.
• Therapy is almost always empirical at initiation (blood-culture turnaround is 24–48 h) and is chosen on likely syndrome + local resistance epidemiology + patient risk; it is de-escalated to the narrowest effective agent once susceptibility returns (monotherapy is the default for a defined pathogen).
• The chronic-carrier state — persistent gallbladder/biliary carriage of S. Typhi with faecal shedding — is a separate pharmacotherapeutic target (eradication of the biliary reservoir), distinct from acute-illness cure; fluoroquinolones can clear chronic faecal carriage.