What are the recommended antibiotic treatments for typhoid fever in adults, and how should I adjust treatment for antibiotic resistance?

Recommended antibiotic treatments for typhoid fever in adults: The UK guidelines do not provide specific first-line antibiotic recommendations for typhoid fever in adults within the provided excerpts. However, in general clinical practice, treatment typically involves antibiotics such as fluoroquinolones, third-generation cephalosporins (e.g., ceftriaxone), or azithromycin, depending on local resistance patterns.

Adjustment of treatment in cases of antibiotic resistance: When antibiotic resistance is suspected or confirmed, treatment should be guided by local antimicrobial susceptibility data and microbiological results. This may involve switching to alternative antibiotics with proven efficacy against resistant strains, such as third-generation cephalosporins if fluoroquinolone resistance is present, or other agents based on culture and sensitivity testing.

General principles: Antibiotic choice should be reviewed and adjusted according to microbiological results to use the narrowest spectrum effective antibiotic. Patients should be reassessed if symptoms worsen or do not improve within 1 to 2 days, or if they become systemically unwell, to consider treatment modification. Safety-netting advice and antimicrobial stewardship principles should be followed to prevent inappropriate use and resistance development.

These recommendations align with the general UK antimicrobial stewardship guidance emphasizing appropriate use, review, and adjustment of antibiotics based on clinical response and microbiological data ¹. Although specific typhoid fever antibiotic regimens are not detailed in the provided guidelines, the approach to managing antibiotic resistance and stewardship is applicable.