Which typhoid fever antibiotic is best for a 36-year-old?

Question

Hi doctor,

I am a 36-year-old male patient. I have been suffering from typhoid for the past one month. After getting my pathology report, the doctor advised me to take one week medication of tablet Cefuroxime 500 mg twice a day. Before this, I had Azithromycin 500 mg.

Is the advice given by the doctor correct?
Which antibiotic will be effective for me?

I have attached my pathology test report for your reference, which includes the Widal test, the latex method for typhoid - TO= 1 : 160, typhoid -TH= 1 : 160, para-typhoid-AO=nil, para-typhoid-AH=1: 80, para-typhoid-BO=Nil, para-typhoid-BH=1: 80.

I shall be grateful for your kind reply.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have reviewed all the details you provided, including the attachment (which has been removed to protect patient identity). I would like to gather more information about your illness.

When you mentioned suffering from this illness for one month, could you please clarify what exactly you mean?
Have you been experiencing continuous fever for the past month?
Additionally, do you have any abdominal pain? Regarding the Azithromycin dosage, how many doses have you taken so far?

I would like to note that the role of serology in diagnosing typhoid fever is limited. If you do not have fever or any other symptoms besides a positive serology report, it is unlikely that you require treatment. More specific investigations for diagnosis of typhoid is blood culture or serology showing titer more than 1:320 or rising titer.

In terms of medication, it is generally recommended to use third-generation Cephalosporin over second-generation ones, such as Cefuroxime. You can use Cefixime 200 mg, one tablet in the morning and one at night for 10 days. This treatment is indicated only if you have a fever or issues related to typhoid fever.

Consult your doctor, discuss with him or her and take the medicine with consent. If you are not experiencing fever, it may be advisable to repeat the Widal test to see if there is a rising titer, which could suggest an acute infection requiring antibiotics.

Please let me know if you have any further questions or if there is anything else I can assist you with.

I hope it helps.

Thank you.