There has recently been some interest in using oral agents after ceftrioxone therapy for the treatment of typhoidal salmonellas. It is widely accepted that in the Indian subcontinent, the levels of ciprofloxacin resistance is increased1. This should be coupled to the fact that in vitro ciprofloxacin susceptibility testing should be backed up with nalidixic acid testing.
The latest BSAC guidelines2, state that azithromycin has been used in the treatment of infections with S. typhi (MIC ≤16 mg/L for wild type isolates) and some enteric infections. Locally we have had a S. typhimurium and an S. paratyphi A, both of which on azithromycin E-testing were found to be 2.0. These have been classed as sensitive.
Duration of treatment: 1 g of azithromycin orally once on the first day, followed by 500 mg given orally once daily on the next 6 days3.