🩺 General MedicineInfectiousStudentInternResident

Enteric Fever (Typhoid)

Also known as: typhoid · typhoid fever · Salmonella Typhi · paratyphoid

A systemic infection by Salmonella Typhi/Paratyphi — stepwise fever, headache, abdominal symptoms and relative bradycardia. Blood culture confirms it; antibiotic resistance is rising.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

People in endemic areas with unsafe water/food (very common in India); spread is faeco-oral.

Red flags — escalate / refer

Third-week complications: intestinal perforation or haemorrhage (peritonitis, GI bleed), altered sensorium (encephalopathy), or shock → emergency.

Work-up / diagnosis

1Blood culture is the gold standard (highest yield in the first week).
2The Widal test has limited reliability; CBC often shows a normal or low white-cell count.
3Watch for complications; notify per local policy.

Management — overview

Start empirical antibiotics guided by local resistance — azithromycin or a third-generation cephalosporin (ceftriaxone) are commonly first-line, as fluoroquinolone resistance is widespread.
Supportive care: hydration, antipyretics and nutrition.
Watch for and manage complications (perforation needs surgery); de-escalate on culture.
Prevent with safe water/food, sanitation and typhoid vaccination.

In-depthFull dosing & advanced protocol

Drug dosing

Azithromycin

Uncomplicated enteric fever

Adult dose: Per local guidance (typical 5–7 day course)
Route: Oral

Caution: Avoid empirical fluoroquinolones where resistance is high.

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

Ceftriaxone

Severe/complicated disease

Adult dose: IV, per guidance
Route: Intravenous

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

Resistance, complications & carriers

MDR and XDR typhoid change first-line choices — follow local antibiograms and de-escalate on culture.
Intestinal perforation (typically the third week) is a surgical emergency.
Chronic carriers (gallbladder) can transmit — identify and treat; vaccination prevents disease.

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Azithromycin

Ceftriaxone

📈 Resistance, complications & carriers

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Azithromycin

Ceftriaxone

📈 Resistance, complications & carriers

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Resistance, complications & carriers

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Resistance, complications & carriers

References