Chloramphenicol was the antibiotic of choice for treatment of enteric fever since its introduction in 1948. It acts by bind-ing to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. Because of low cost, for sensitive S. Typhi strains, chloramphenicol is still used to treat typhoid fever.
At present, the fluoroquinolones (e.g., ciprofloxacin, pefloxa-cin, norfloxacin) and the third-generation cephalosporins (e.g., ceftazidime, ceftriaxone, cefotaxime) are the antibiotics of choice for treatment of multidrug-resistant S. Typhi. They are increas-ingly used for typhoid fever because of their efficacy and low relapse and low carrier rates associated with their use.
Cefotaxime prevents bacterial cell wall synthesis, which inhibits bacterial growth. The antibiotic shows excellent in vitro activity against S. Typhi and other salmonellae, andhas acceptable efficacy in typhoid fever. Recently, emergence of domestically acquired ceftriaxone-resistant Salmonella infections has been described. The cost and need for intravenous administration are the noted disadvantages of third-generation cephalosporins, particularly in developing countries.
A 14-day course of chloramphenicol, ampicillin, or trime-thoprim and sulfamethoxazole is indicated for S. Typhi infection.