Diagnosis, Treatment and Management of Typhoid Fever and the Role
R.H.H. Nelwan, MD
Professor, Chief Division of Tropical and Infectious Diseases,
Department of Internal Medicine, Faculty of Medicine University
Typhoid fever remains prevalent in varying degrees throughout the
developing world, resulting in a substantial economic and social
burden through the loss of income and possible loss of life. The
efficacy of older fluoroquinolones has been proven and some fluoroquinolones
have been recommended as the drug of choice for the treatment of
typhoid fever. In our clinical study, we evaluated the safety and
efficacy of levofloxacin due to its excellent activity, as defined
by minimum inhibitory concentrations (MICs), against all Salmonella
spp., the principle cause of typhoid fever.
Fifty-three adult hospitalized male and female patients with suspect
typhoid fever were screened and those without complications, serious
underlying conditions, or pregnancy or lactation were enrolled in
the study. The 48 enrolled patients were given levofloxacin 500
mg o.d. for a period of one week. Diagnosis was confirmed by positive
blood culture, polymerase chain reaction (PCR), or serology in 30
patients (11 males and 19 females) aged 18-58 years. All patients
had a history of fever lasting 1-10 days; the mean was 6.1 days.
All patients showed excellent clinical response to treatment, becoming
afebrile at an average of 2.43 days in confirmed cases (n
= 21) and 2.22 days in probable cases (n = 9). We noted adverse
skin reactions of possible allergic nature in two cases (4.2%).
It can be concluded that the clinical efficacy and safety of levofloxacin
in our clinical study was excellent and that levofloxacin should
be studied more intensively for the treatment of typhoid fever.