Intended for healthcare professionals


Treatment of enteric fever

BMJ 2009; 338 doi: (Published 03 June 2009) Cite this as: BMJ 2009;338:b1159
  1. Christopher M Parry, senior lecturer (honorary consultant)1,
  2. Nick J Beeching, senior lecturer (honorary consultant)2
  1. 1School of Infection and Host Defence, University of Liverpool, Liverpool L69 3GA
  2. 2Liverpool School of Tropical Medicine, Liverpool L3 5QA
  1. cmparry{at}

    Fluoroquinolones remain the best option in areas where resistance is uncommon

    Enteric fever (typhoid and paratyphoid), caused by Salmonella enterica serovar Typhi or serovar Paratyphi A, represents a major burden of disease in communities that lack clean water and adequate sanitation. More than 27 million cases of enteric fever occur worldwide each year, with 216 000 deaths.1 Community based studies in Asia have shown a yearly incidence greater than 400/100 000 population in infants and children.2 In developed countries, returning travellers or those visiting friends and relatives in their family’s country of origin are at risk.3 In endemic areas, most patients are treated with oral antibiotics as outpatients, and only those with severe disease need hospital admission. Relapse may complicate the illness, and faecal carriage can become chronic and lead to onward transmission. In the linked systematic review (doi:10.1136/bmj.b1865), Thaver and colleagues compare the effectiveness of fluoroquinolones as firstline agents with that of other antibiotics for treating enteric fever.4

    Until the late 1980s, two to three …

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