# Typhoid fever - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian MOH Typhoid Protocol 2020 · WHO Typhoid Fever 2018 · Typhoid Fever - disease-level clinical article (typhoid-fever-clinical.txt) · Egyptian National Drug Formulary - Endocrine · Egyptian National Drug Formulary - Antimicrobial 2023 (cefixime monograph) - Verified date: 2026-08 ## Verified against - Egyptian MOH Typhoid Protocol 2020 - Typhoid Fever - disease-level clinical article (typhoid-fever-clinical.txt) - Egyptian National Drug Formulary - Endocrine - Egyptian National Drug Formulary - Antimicrobial 2023 (cefixime monograph) ## Treatment metadata - Azithromycin — 500 mg — oral.solid - Ceftriaxone — 1000 mg — injection - Referral & safety-netting (no drug therapy) - Ciprofloxacin — 500 mg — oral.solid - Cefixime — 200 mg — oral.solid - Dexamethasone — 4 mg — injection ## Complete treatment card ```text TYPHOID FEVER Sources: Egyptian MOH Typhoid Protocol 2020 · WHO Typhoid Fever 2018 · Typhoid Fever - disease-level clinical article (typhoid-fever-clinical.txt) · Egyptian National Drug Formulary - Endocrine · Egyptian National Drug Formulary - Antimicrobial 2023 (cefixime monograph) Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Fever climbs in a stepwise pattern over the first few days, reaching 38-40C by day 3 or 4, typically lowest in the morning and peaking later [fever] - Loss of appetite, headache, and malaise are almost always present [headache · malaise · poor appetite] - Children more often present with diarrhea, vomiting, or febrile seizures than adults do [diarrhoea · fever · seizures · vomiting] - Pale stools with dark urine can signal a hepatitis or biliary complication [pale stools] - Severe epigastric pain radiating to the back suggests pancreatitis as a complication [abdominal pain · epigastric pain] SIGNS - what you find (5) - Patients often look pale, lethargic, and dehydrated early on, becoming toxic-appearing with notable weight loss if untreated [dehydration · lethargy · pallor · weight loss] - Rose spots - blanching, 2-4 mm raised red marks mainly over the chest and abdomen - appear in under a quarter of patients and are hard to see in darker skin - A slower-than-expected pulse for the fever can occur in the first week, though it isn't a reliable sign [fever] - Liver and spleen enlargement is found in roughly a third to half of cases - Rebound tenderness, rigidity, and guarding appearing later in the illness suggest bowel bleeding or perforation [bleeding · guarding · rebound tenderness] TESTS (7) - Blood or bone marrow culture, the gold-standard test, is 100% specific - A single blood culture in endemic areas is only positive about 50-66% of the time - Blood culture is much more sensitive in travelers, over 90% - Stool culture is unreliable for diagnosing acute infection since it can also be positive during convalescence or chronic carriage - The Widal test uses an antibody titer above 1:160 for anti-H and above 1:80 for anti-O antigen as the usual cutoff for recent infection - Fever on at least 3 of the first 7 days is enough to suspect and start treating this in someone from an endemic area - Roughly 15-25% of patients develop low white cell counts, while young children more often show high white counts and anemia IF NOT THIS - what else fits (9) - Malaria is the condition most often confused with this on presentation - Shaking chills (rigors) are more typical of malaria than of this condition - Taking antimalarial prophylaxis doesn't rule out malaria as the cause of the fever - Amoebiasis spreads the same fecal-oral way and can also cause fever, bloody diarrhea, and abdominal pain - A bite mark that starts like a cigarette burn and becomes a black scab points toward typhus instead - Profuse diarrhea is more typical of bacterial gastroenteritis than this condition - A prominent cough with upper respiratory symptoms points more toward influenza or COVID-19 - Severe joint pain is more suggestive of dengue than of this condition - Returning home more than 6 days before symptoms started rules out yellow fever, dengue, and chikungunya Source StatPearls "Typhoid Fever" - disease-level clinical article Status traced to the source above Rx: Uncomplicated - oral | Severe - inpatient | Main treatment | Oral alternative to ceftriaxone UNCOMPLICATED - ORAL 1. AZITHROMYCIN [1st line] Adult 500 mg once daily x 7 days Peds 10-20 mg/kg/day [child max 500 mg] (Once daily for 7 days) 3kg -> 30-60 mg/day 4kg -> 40-80 mg/day 5kg -> 50-100 mg/day 6kg -> 60-120 mg/day 7kg -> 70-140 mg/day 8kg -> 80-160 mg/day 9kg -> 90-180 mg/day 10kg -> 100-200 mg/day 11kg -> 110-220 mg/day 12kg -> 120-240 mg/day 13kg -> 130-260 mg/day 14kg -> 140-280 mg/day 15kg -> 150-300 mg/day 16kg -> 160-320 mg/day 17kg -> 170-340 mg/day 18kg -> 180-360 mg/day 19kg -> 190-380 mg/day 20kg -> 200-400 mg/day 21kg -> 210-420 mg/day 22kg -> 220-440 mg/day 23kg -> 230-460 mg/day 24kg -> 240-480 mg/day 25kg -> 250-500 mg/day 26kg -> 260-500 mg/day (upper capped) 27kg -> 270-500 mg/day (upper capped) 28kg -> 280-500 mg/day (upper capped) 29kg -> 290-500 mg/day (upper capped) 30kg -> 300-500 mg/day (upper capped) 31kg -> 310-500 mg/day (upper capped) 32kg -> 320-500 mg/day (upper capped) 33kg -> 330-500 mg/day (upper capped) 34kg -> 340-500 mg/day (upper capped) 35kg -> 350-500 mg/day (upper capped) 36kg -> 360-500 mg/day (upper capped) 37kg -> 370-500 mg/day (upper capped) 38kg -> 380-500 mg/day (upper capped) 39kg -> 390-500 mg/day (upper capped) 40kg -> 400-500 mg/day (upper capped) 41kg -> 410-500 mg/day (upper capped) 42kg -> 420-500 mg/day (upper capped) 43kg -> 430-500 mg/day (upper capped) 44kg -> 440-500 mg/day (upper capped) 45kg -> 450-500 mg/day (upper capped) 46kg -> 460-500 mg/day (upper capped) 47kg -> 470-500 mg/day (upper capped) 48kg -> 480-500 mg/day (upper capped) 49kg -> 490-500 mg/day (upper capped) 50kg -> 500 mg/day (capped) AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian MOH Typhoid Protocol 2020 Why Macrolide antibiotic with good oral bioavailability against Salmonella typhi; an oral option for uncomplicated typhoid fever caused by resistant strains, avoiding the need for injectable therapy. Caution Azithromycin is an oral option for uncomplicated resistant Salmonella typhi. There is a QT prolongation risk. GI intolerance can occur at higher doses. Egypt AZATRIBACT 500MG 3 CAPS. RIVA PHARMA S... 13.50 EGP (4.50/unit) GIGAZOCIN 500MG 5 CAPS. EGPI > PIONEER 27.50 EGP (5.50/unit) SYSTYMYCIN 500MG 3 CAPS. EGPI > NOVELL... 21.50 EGP (7.17/unit) AZITHROMASH 500 MG 3 F.C. TABS. MASH PREMIERE 48.00 EGP (16.00/unit) AZALIDE 500MG 3 CAPS. UP PHARMA 52.00 EGP (17.33/unit) AZROLID 500 MG 6 F.C.TABS. AMRIYA 126.00 EGP (21.00/unit) ZERAMERATE 500 MG EGPI > GAMMA ... 28.50 EGP DISTABCIN 500 MG 3 DISPERSIBLE TABS. EGPI 43.50 EGP ZITHRODOSE 100MG/5ML SUSP. 15ML EL-OBOUR > AV... 12.00 EGP -> ? strength differs, ? different route - not oral solid ZITHROPHATE 200MG/5ML SUSP. 15ML ORGANO PHARMA... 12.75 EGP -> ? strength differs, ? different route - not oral solid SEVERE - INPATIENT 2. CEFTRIAXONE [1st line] Adult 1-2 g IV once daily x 7-14 days Peds 50-80 mg/kg/day [child max 2000 mg] (IV once daily for 7-14 days) 3kg -> 150-240 mg/day 4kg -> 200-320 mg/day 5kg -> 250-400 mg/day 6kg -> 300-480 mg/day 7kg -> 350-560 mg/day 8kg -> 400-640 mg/day 9kg -> 450-720 mg/day 10kg -> 500-800 mg/day 11kg -> 550-880 mg/day 12kg -> 600-960 mg/day 13kg -> 650-1040 mg/day 14kg -> 700-1120 mg/day 15kg -> 750-1200 mg/day 16kg -> 800-1280 mg/day 17kg -> 850-1360 mg/day 18kg -> 900-1440 mg/day 19kg -> 950-1520 mg/day 20kg -> 1000-1600 mg/day 21kg -> 1050-1680 mg/day 22kg -> 1100-1760 mg/day 23kg -> 1150-1840 mg/day 24kg -> 1200-1920 mg/day 25kg -> 1250-2000 mg/day 26kg -> 1300-2000 mg/day (upper capped) 27kg -> 1350-2000 mg/day (upper capped) 28kg -> 1400-2000 mg/day (upper capped) 29kg -> 1450-2000 mg/day (upper capped) 30kg -> 1500-2000 mg/day (upper capped) 31kg -> 1550-2000 mg/day (upper capped) 32kg -> 1600-2000 mg/day (upper capped) 33kg -> 1650-2000 mg/day (upper capped) 34kg -> 1700-2000 mg/day (upper capped) 35kg -> 1750-2000 mg/day (upper capped) 36kg -> 1800-2000 mg/day (upper capped) 37kg -> 1850-2000 mg/day (upper capped) 38kg -> 1900-2000 mg/day (upper capped) 39kg -> 1950-2000 mg/day (upper capped) 40kg -> 2000 mg/day (capped) 41kg -> 2000 mg/day (capped) 42kg -> 2000 mg/day (capped) 43kg -> 2000 mg/day (capped) 44kg -> 2000 mg/day (capped) 45kg -> 2000 mg/day (capped) 46kg -> 2000 mg/day (capped) 47kg -> 2000 mg/day (capped) 48kg -> 2000 mg/day (capped) 49kg -> 2000 mg/day (capped) 50kg -> 2000 mg/day (capped) AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian MOH Typhoid Protocol 2020 Why Third-generation cephalosporin with broad activity against Salmonella typhi; preferred empirical therapy for typhoid fever in Egypt because of high resistance to older first- line agents. Caution Ceftriaxone is the preferred empirical first-line therapy in Egypt due to resistance. Avoid in neonates with hyperbilirubinemia or IV calcium. Monitor renal and hepatic function during extended therapy. Egypt ZOXIDEL 1 GM PD. FOR I.M. INJ. RAMEDA > DELT... 22.00 EGP CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA) KAHIRA 29.00 EGP ZOXIDEL 1 GM PD. FOR I.V. INJ. RAMEDA > DELT... 29.00 EGP WINTRIAXONE 1 GM PD. FOR I.V INJ. SANOFI 48.00 EGP VOTRIAXONE 1 GM I.M VIAL CHEMIPHARM 56.00 EGP OFRAMAX 1 GM I.M. VIAL RAMEDA > SUN ... 71.00 EGP TRIAXONE 1 GM I.M. VIAL TABUK PHARMAC... 106.00 EGP TRIAXONE 1 GM I.V VIAL TABUK PHARMAC... 106.00 EGP MAIN TREATMENT - choose one, plus any add-on marked below 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Typhoid Fever - disease-level clinical article (typhoid-fever-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - The WHO definition of severe illness that determines the inpatient/IV treatment pathway is confirmed or suspected intestinal perforation, peritonitis, sepsis, or septic shock. RED FLAG - Surgical referral is required for intestinal perforation. 4. CIPROFLOXACIN [2nd line] Adult 500 mg BID x 7-14 days Peds Reserve for pediatric cases where benefits outweigh joint risks AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian MOH Typhoid Protocol 2020 Why Ciprofloxacin is held at second line here. StatPearls ties the choice to local resistance: where ciprofloxacin resistance runs high - as it is across much of Asia and sub-Saharan Africa - azithromycin becomes the preferred agent for adults with mild enteric fever, while in areas of low fluoroquinolone resistance, ciprofloxacin is preferred instead. Egypt fits neither region the article names, and its S. typhi fluoroquinolone resistance rate is not documented in the cited sources, so ciprofloxacin stays second line, reserved for isolates confirmed susceptible. Caution Switch to ceftriaxone if the response is delayed. The local S. typhi fluoroquinolone resistance rate is not documented in the cited sources, so treat a slow response as possible resistance rather than waiting it out. Reserved for isolates confirmed susceptible. The disease article gives azithromycin as the drug of choice where ciprofloxacin resistance is prevalent, and ciprofloxacin only where fluoroquinolone resistance is low; which of the two describes Egypt is not established in the cited sources. QT prolongation and CNS toxicity can occur. There is a risk of tendinitis and tendon rupture. Egypt QUINOLOROX 500MG 10 F.C. TAB. EPCI > ROXXEN 10.00 EGP (1.00/unit) ECACIPROFLOX 500 MG 20 F.C. TABS. FUTURE PHARMACEUTICAL INDU... 27.00 EGP (1.35/unit) ELMODOXACIN 500MG 10 F.C.TAB. EGPI > SEA PHARM 20.00 EGP (2.00/unit) CIPROQUIN 500MG 10 F.C. TAB. UNIPHARMA 50.00 EGP (5.00/unit) CIPROFLOXACIN-ORGANO 500 MG 10 F.C.TABS. ORGANOPHARMA > ORGANO 63.00 EGP (6.30/unit) CIPROFAR 500MG 10 F.C.TAB. PHARCO 69.00 EGP (6.90/unit) CIPROMEGA XL 500MG 10 EXT. REL. F.C.TABS. MASH PREMIERE 48.00 EGP HEROXACIN 500MG 10 SCORED F.C. TAB. EGPI > HERO PHARM 69.00 EGP 5. DEXAMETHASONE [add-on - not a substitute] Adult Oral, IV, IM: 4 to 20 mg/day given in a single daily dose or 2 to 4 divided doses Peds Child: 0.15 to 0.6 mg/kg (max 16 mg) once daily. Source Egyptian National Drug Formulary - Endocrine Why Corticosteroid adjunct for severe typhoid with CNS involvement or shock; given only with concomitant anti-infective therapy. The source for this condition specifies a weight- based regimen (3 mg/kg IV then 1 mg/kg q6h x 8 doses) that exceeds the formulary's general range. Caution Adrenal suppression may persist for 6 to 12 months after discontinuation. May provoke new-onset hyperglycemia or exacerbation of diabetes mellitus. Dexamethasone has immunosuppressive and anti-inflammatory effects that are reversible with discontinuation. Use only with concomitant anti-infective therapy. Egypt F-CORTEN 4MG/ML 3 AMPS. MEMPHIS 12.00 EGP EPIDRON 4MG/ML VIAL 2 ML EIPICO 13.00 EGP ORAL ALTERNATIVE TO CEFTRIAXONE 6. CEFIXIME [2nd line] Adult 400 mg daily, divided every 12 to 24 hours Peds 8 mg/kg/day [child max 400 mg] (ENDF: infants, children and adolescents, 8 mg/kg/day divided every 12 to 24 hours; maximum daily dose 400 mg/day.) 3kg -> 24 mg/day 4kg -> 32 mg/day 5kg -> 40 mg/day 6kg -> 48 mg/day 7kg -> 56 mg/day 8kg -> 64 mg/day 9kg -> 72 mg/day 10kg -> 80 mg/day 11kg -> 88 mg/day 12kg -> 96 mg/day 13kg -> 104 mg/day 14kg -> 112 mg/day 15kg -> 120 mg/day 16kg -> 128 mg/day 17kg -> 136 mg/day 18kg -> 144 mg/day 19kg -> 152 mg/day 20kg -> 160 mg/day 21kg -> 168 mg/day 22kg -> 176 mg/day 23kg -> 184 mg/day 24kg -> 192 mg/day 25kg -> 200 mg/day 26kg -> 208 mg/day 27kg -> 216 mg/day 28kg -> 224 mg/day 29kg -> 232 mg/day 30kg -> 240 mg/day 31kg -> 248 mg/day 32kg -> 256 mg/day 33kg -> 264 mg/day 34kg -> 272 mg/day 35kg -> 280 mg/day 36kg -> 288 mg/day 37kg -> 296 mg/day 38kg -> 304 mg/day 39kg -> 312 mg/day 40kg -> 320 mg/day 41kg -> 328 mg/day 42kg -> 336 mg/day 43kg -> 344 mg/day 44kg -> 352 mg/day 45kg -> 360 mg/day 46kg -> 368 mg/day 47kg -> 376 mg/day 48kg -> 384 mg/day 49kg -> 392 mg/day 50kg -> 400 mg/day AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 (cefixime monograph) Why The disease article gives cefixime as the oral alternative when ceftriaxone - an injection - is not practical; the card's only oral third-generation option was none. Caution Hypersensitivity to cefixime, any component of the formulation, or other cephalosporins or penicillins The ENDF gives a general dosage range and does not state a typhoid-specific course length - the indication and the duration come from the disease article. Egypt VIODRILNEX 200 MG 21 CAPS. SIGMA TEC > H... 69.00 EGP (3.29/unit) CEFABRUM 200MG 8 TAB. ALFACURE PHAR... 38.00 EGP (4.75/unit) XIMACEF 200 MG 8 CAPSULE SIGMA 42.00 EGP (5.25/unit) HEBIXIME 200MG 8 CAPS. SHIFA MEDICAL... 48.00 EGP (6.00/unit) CEFALOTRIGENEX 200MG 8 F.C. TABS. SHIFA MEDICAL PRODUCTS > N... 66.50 EGP (8.31/unit) SUPRAX 200 MG 8 CAPS. KAHIRA > HIKM... 138.00 EGP (17.25/unit) VIODRILNEX 100MG/5ML SUSP. 30ML BADR PHARMA >... 21.50 EGP -> ? strength differs, ? different route - not oral solid CEFABRUM 100MG/5ML SUSP. 60ML ALFACURE PHAR... 27.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)