CDC issues guidance on treating drug-resistant typhoid fever

The Centers for Disease Control and Prevention Friday released recommendations for treating Extensively Drug-Resistant Salmonella Typhi, a systemic illness transmitted through contaminated food and water and person-to-person contact.

Following a large outbreak in Pakistan in 2016, CDC has received at least 71 reports of XDR Typhi infection in the United States, including at least nine cases since November 2019 in patients who had not traveled internationally. XDR Typhi strains are resistant to antibiotics generally recommended to treat typhoid fever, including ampicillin, ceftriaxone, chloramphenicol, ciprofloxacin and trimethoprim-sulfamethoxazole.

“Clinicians should consider empiric treatment with a carbapenem, azithromycin, or both agents for suspected typhoid fever in patients who did not travel out of the United States and for those who traveled to Pakistan or Iraq,” CDC said. “Ceftriaxone remains an appropriate empiric treatment option for patients who traveled to countries other than Pakistan and Iraq. Clinicians should adjust treatment based on results of susceptibility testing.”