Salmonella typhi and S. Paratyphi rev. tables

Table 1. Extra-intestinal Infectious Complications of Typhoid Fever Caused by Salmonella enterica serotype Typhi

Organ system involved	Prevalence	Risk factors	Complications
Central Nervous System	3-35%	Residence in endemic region,²¹⁷ malignancy,²¹⁸ endocarditis, congenital heart disease, paranasal sinus infections, pulmonary infections, meningitis, trauma, surgery, and osteomyelitis of the skull	Encephalopathy,²¹⁹ cerebral edema,²¹⁷ subdural empyema,²²⁰ cerebral abscess,^{218, 221} meningitis,²²² ventriculitis, transient Parkinsonism, motor neuron disorders, ataxia,²⁰ seizures, Guillain-Barré syndrome, psychosis²²³
Cardiovascular	1-5%	Cardiac abnormalities such as existing valvular abnormalities, rheumatic heart disease or congenital heart defects²²⁴	Endocarditis,^{225, 226,227,228}myocarditis,²²³ pericarditis,²²⁹ arteritis, congestive heart failure²³⁰
Pulmonary	1%	Residence in endemic region, past pulmonary infection, sickle cell anemia, alcohol abuse, diabetes, HIV infection³⁰	Pneumonia,^{30, 231} empyema,²³² bronchopleural fistula, infected pulmonary hydatid cyst²³³
Bone and Joint	< 1%	Sickle cell anemia, diabetes, systemic lupus erythematosus, lymphoma, liver disease, previous surgery or trauma, those at extremes of age, and steroid use²³⁴	Osteomyelitis,^{62, 223, 234,235,236,237,238,239} septic arthritis²⁴⁰
Hepatobiliary	1-26%	Residence in endemic region, pyogenic infections, intravenous drug use, splenic trauma, HIV, hemoglobinopathy	Cholecystitis, hepatitis,^{223, 241} hepatic abscesses²⁴², splenic abscess,^{243, 244,245} peritonitis, paralytic ileus²²³
Genitourinary	<1%	Urinary tract, pelvic pathology and systemic abnormalities	Urinary tract infection,^{55, 246} renal abscess, pelvic infections,²⁴⁷ testicular abscess, prostatitis, epididymitis
Soft tissue infections	17 cases reported in the English literature	Diabetes²⁴⁸	Psoas abscess^{248, 249} gluteal abscess,²⁵⁰ cutaneous vasculitis,²⁵¹
Hematologic	5 cases reported in the English literature		Hemophagocytosis syndrome^{252, 253}

Abbreviations: HIV – human immunodeficiency virus

Table 2. Minimum Inhibitory Concentrations (μg /ml) for Selected Antibiotics Against Salmonella typhi

*Pefloxacin or fleroxacin have both proved very effective as well (Table 2). The three days course is particularly useful in epidemic

**Dexamethasone 3mg/kg I.V. stat followed by 1mg/kg six hourly for 48 hours should be given to patients with encephalopathy or

shock unrelated to perforation or hemorrhage. For quinolone resistant infections substitute ceftriaxone.

	"Sensitive isolates"		"MDR isolates"
	MIC₅₀	MIC₉₀	MIC₅₀	MIC₉₀
Penicillin G	4	8
Ampicillin	0.5	1.0	>256	>256
Amoxicillin-Clavulanic acid	0.5	1.0	8	8
Piperacillin	0.5	1
Piperacillin-Tazobactam	0.5	1
Ticarcillin	2	4
Azlocillin	8	8
Mezlocillin	2	2
Mecillinam	0.125	0.125	1*	2*
Cefuroxime	2	4
Cefoperazone	1	4
Cefoxitin	1	4
Ceftriaxone	0.06	0.125	0.06	0.125
Ceftazidime	0.25	0.25
Cefepime	0.06	0.125
Cefpirome	0.06	0.06
Cefixime	0.06	0.06
Ceftizoxime	0.06	0.125
Aztreonam	0.125	0.25
Imipenem	0.25	0.5
Meropenem	0.06	0.06
Azithromycin	8	8	8	8
Rifampicin	8	16
Trimethoprim	0.125	0.25	128	>256
Sulfamethoxazole	4	16	>256	>256
Chloramphenicol	4	8	>256	>256
Tetracycline	1	1	>256	>256
Gentamicin	0.25	2.0
Nalidixic acid	4	8	4	8
Norfloxacin	0.06	0.25	0.06	0.25
Ciprofloxacin	0.015	0.03	0.015	0.03
Ofloxacin	0.06	0.125	0.06	0.125
Pefloxacin	0.125	0.125	0.125	0.125

Drug	Reference	Dosage	Patients	Clinical cure %	Micro cure %	FCT (days)	Relapse Rate %
Ofloxacin	Morelli et al 1992¹²⁰	300 mg tid 15 days	30	100	100	2.6	0
Pefloxacin	Morelli et al 1992¹²⁰	400 mg tid 15 days	36	100	100	3.7	0
Ciprofloxacin	Morelli et al 1992¹²⁰	500 mg tid 15 days	20	100	100	3.3	0
Enoxacin	Morelli et al 1992¹²⁰	300 mg tid 15 days	20	80	80	4.6	0
Norfloxacin	Morelli et al 1992¹²⁰	400 mg tid	20	60	60	4.6	0
Norfloxacin	Sarma & Durairaj 1991¹²¹	400mg bid 7 days	20	100	100	3.7	0
Ciprofloxacin	Uwayda et al 1992²⁵⁴	500mg bid, 7-10 days	34	100	100	4.9	0
Ciprofloxacin	Uwayda et al 1992²⁵⁴	750mg bid, 7-10 days	28	100	100	5.2	4
Fleroxacin	Arnold et al 1993¹⁴⁵	400mg od, 7 days	28	83	96	4	17
Fleroxacin	Arnold et al 1993¹⁴⁵	400mg od, 14 days	35	100	97	4	0
Ciprofloxacin	Wallace et al 1993¹⁶¹	500mg bid, 7 days	20	100	100	4	0
Fleroxacin	Hien et al 1994¹⁵⁹	400mg od, 7 days	15	100	100	3.4	0
Ofloxacin	Smith et al 1994¹⁶⁰	200mg bid, 5 days	22	100	100	3.4	0
Ciprofloxacin	Alam et al 1995⁷⁶	500mg bid, 10 days	35	100	100	4.2	0
Ciprofloxacin	Alam et al 1995⁷⁶	500mg bid, 14 days	34	100	100	4.9	0
Ofloxacin	Smith et al 1995¹⁶⁰	15mg/kg/d 3 days	118	100	100	2.5	0
Ofloxacin	Smith et al 1995¹⁶⁰	10mg/kg/d 5 days	110	100	100	3.0	1
Fleroxacin	Duong et al 1995²⁵⁵	400mg od, 5 days	41	97.5	100	3.4	4
Fleroxacin	Duong et al 1995²⁵⁵	400mg od, 3 days	22	100	100	3.7	0
Ofloxacin	Vinh et al 1996¹⁶²	15mg/kg/d 3 days	47	96	100	4.5	0
Ofloxacin	Vinh et al 1996¹⁶²	15mg/kg/d 2 days	53	89	98	4.5	2
Pefloxacin	Unal et al 1996²⁵⁶	400mg bid 7 days	24	100	100	3.4	4
Pefloxacin	Unal et al 1996²⁵⁶	400mg bid 5 days	22	100	96	3.1	0
Ofloxacin	Chinh et al 1997¹³⁵	15mg/kg/d 3 days	53	89	100	4.0	2
Ofloxacin	Chinh et al 1997¹³⁵	15mg/kg/d 2 days	47	98	98	4.0	0
Ofloxacin	Secmeer et al 1997²⁵⁷	40mg/kg/d	24	100	100	3.3	0
Ciprofloxacin	Girgis et al 1999²⁵⁸	500mg bid 7 days	28	100	100	3.3	0
Ofloxacin	Cao et al 1999²⁵⁹	10mg/kg/d 5 days	38	97	100	4.4	0
Ofloxacin*	Chinh et al 2000⁷⁹	8mg/kg/d 5 days	44	86	95.5	5.6	5
Ciprofloxacin	Gasem et al 2003⁷⁰	500mg/d 7d	28	96	82	5.1	0
Ofloxacin	Vinh et al 2005¹⁷⁰	10mg/kg/d 3 days	107	95.3	99.1	4.21	2.8
Ofloxacin	Vinh et al 2005¹⁷⁰	10mg/kg/d 2 days	89	91.3	95.5	3.83	2.2

	Reference	Dosage	No of patients	Clinical Cure (%)	Micro Cure (%)	mean (SD) FCT(days) or range	Relapse Rate(%)
Cefotaxime	Soe et al 1987¹¹⁵	200mg/kg /day 6-14 d	61	82			6
Ceftriaxone	Islam et al 1988¹⁴⁹	3-4g/day, 7 d	32	91	100	4->14	6
Ceftriaxone	Lasserre et al 1991²⁶⁰	3g/day,3 d	19	95	100	3-13	11
Ceftriaxone	Lasserre et al 1991²⁶⁰	4g/day, 3 d	20	100	100	4-11	0
Ceftriaxone	Wallace et al 1993¹⁶¹	3g/day, 7 d	22	73	100	5.2	5
Ceftriaxone	Islam et al 1993¹⁴⁹	4g/day, 5 d	28	79	100		4
Ceftriaxone	Tran et al 1994¹⁵⁹	2g/day, 5 d	15	87	93	6.7	0
Ceftriaxone	Smith et al 1994¹⁶⁰	3g/day, 3 d	25	72	92	8.2	4
Ceftriaxone	Bhutta et al 1994⁷⁷	65mg/kg /day, 14 d	25	88	88	8.0	14
Cefixime	Bhutta et al 1994⁷⁷	20mg/kg /day, 12+ d	50	100	100	5.3	4
Cefixime	Girgis et al 1994¹⁵⁸	10mg/kg /day, 14 d	25	88	96	8.3	4
Cefixime	Girgis et al 1995¹⁷⁸	7.5mg/kg bid, 14d	50	100	100	5.3	6
Ceftriaxone	Girgis et al 1995¹⁷⁸	50-70mg/kg daily, 5 d	43	100	100	3.9	5
Cefixime	Rabbani et al 1998²⁶¹	10mg/kg/d 14d	20	90	90		6
Cefixime	Cao et al 1999²⁵⁹	20mg/kg/d 7d	44	75	90	8.5	2
Ceftriaxone	French et al 2000²⁶²	75mg/kg/d 7d	30	97	97	3.9	13
Ceftriaxone	Bhutta et al 2000¹⁷¹	6mg/kg/d 7d	29	93	100	5.4	4
Ceftriaxone	Bhutta et al 2000¹⁷¹	65mg/kg/d 14d	28	96	100	5.2	0
Ceftriaxone	Frenck et al 2004²⁶³	75mg/d 5d	36	81	97	3.6	14

Reference	Dosage	Patients	Clinical cure %	Micro cure %	FCT (days)	Relapse Rate %
Butler et al 1999²⁶⁴	9.6 mg/kg/d 7 days	42	88	100	4.1	0
Girgis et al 1999²⁵⁸	16 mg/kg followed by 8 mg/kg total 7 days	36	100	100	3.8	0
Chinh et al 2000⁷⁹	20 mg/kg/d 5 days	44	96	98	5.5	0
Frenck et al 2000²⁶²	10 mg/kg/d 7 days	34	91	97	4.1	0
Frenck et al 2004²⁶³	20 mg/kg/d 5 days	32	100	100	4.5	0

	Endemic area	Non-immune
Uncomplicated enteric fever	Ofloxacin or ciprofloxacin orally 7.5mg/kg b.i.d or levofloxacin orally 500mg daily for 3-5 days*	Ofloxacin or ciprofloxacin orally 7.5mg/kg b.i.d or levofloxacin orally 500mg daily for 5-7 days*
Severe typhoid**	Ofloxacin or ciprofloxacin 7.5mg/kg infused over 30-60 minutes every 12 hours or levofloxacin 500mg infused every 24 hours until oral treatment can be substituted. Continue same dose for 10-14 days.	Ofloxacin or ciprofloxacin 7.5mg/kg infused over 30-60 minutes every 12 hours or levofloxacin 500mg infused every 24 hours until oral treatment can be substituted. Continue same dose for 10-14 days. Immunocompromised patients should receive at least three weeks treatment.
Carriers	Adults: Ofloxacin or Ciprofloxacin orally 7.5 mg/kg b.i.d. or levofloxacin orally 500mg daily for 4 weeks. Children: Amoxicillin 10mg/kg/day for 6-8 weeks plus probenecid

	Uncomplicated enteric fever	Severe typhoid
Chloramphenicol	75mg/kg/day in 4 divided oral doses for 14 days	Chloramphenicol succinate 75mg/kg/day I.V. or I.M. in 4 divided doses until oral treatment can be substituted. Then 50mg/kg/day orally for 14-21 days
Ampicillin/amoxicillin	Amoxicillin 75-100mg/kg/day in 3-4 divided oral doses for 14 days	Ampicillin 15mg/kg/day I.V. in 4 divided doses for 14-21 days
Trimethoprim/ sulfamethoxazole	8/40 mg/kg/day in 2 divided oral doses (corresponding in adults to 2-3 tablets b.i.d.) 14 days.	Intravenous dose regimen similar to the oral regimen
Cefixime/ceftriaxone	Cefixime 20mg/kg/day in 4 divided oral doses for 7-10 days	Ceftriaxone 60 mg/kg/day I.V. or I.M. for at least 5 days, then if possible switch to oral therapy to complete 14-21 days treatment