Dawaa Reference

infectious

Typhoid fever

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 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 against4 documents
  • 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)

Verified date2026-08

Presentation reference

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

SourceStatPearls "Typhoid Fever" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Uncomplicated - oral | Severe - inpatient | Main treatment | Oral alternative to ceftriaxone

UNCOMPLICATED - ORAL

1

AZITHROMYCIN

Uncomplicated - oral

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg once daily x 7 days

Paediatric dose

10-20 mg/kg/day [child max 500 mg] (Once daily for 7 days)

Dose by weight
3kg30-60 mg/day
4kg40-80 mg/day
5kg50-100 mg/day
6kg60-120 mg/day
7kg70-140 mg/day
8kg80-160 mg/day
9kg90-180 mg/day
10kg100-200 mg/day
11kg110-220 mg/day
12kg120-240 mg/day
13kg130-260 mg/day
14kg140-280 mg/day
15kg150-300 mg/day
16kg160-320 mg/day
17kg170-340 mg/day
18kg180-360 mg/day
19kg190-380 mg/day
20kg200-400 mg/day
21kg210-420 mg/day
22kg220-440 mg/day
23kg230-460 mg/day
24kg240-480 mg/day
25kg250-500 mg/day
26kg260-500 mg/day (upper capped)
27kg270-500 mg/day (upper capped)
28kg280-500 mg/day (upper capped)
29kg290-500 mg/day (upper capped)
30kg300-500 mg/day (upper capped)
31kg310-500 mg/day (upper capped)
32kg320-500 mg/day (upper capped)
33kg330-500 mg/day (upper capped)
34kg340-500 mg/day (upper capped)
35kg350-500 mg/day (upper capped)
36kg360-500 mg/day (upper capped)
37kg370-500 mg/day (upper capped)
38kg380-500 mg/day (upper capped)
39kg390-500 mg/day (upper capped)
40kg400-500 mg/day (upper capped)
41kg410-500 mg/day (upper capped)
42kg420-500 mg/day (upper capped)
43kg430-500 mg/day (upper capped)
44kg440-500 mg/day (upper capped)
45kg450-500 mg/day (upper capped)
46kg460-500 mg/day (upper capped)
47kg470-500 mg/day (upper capped)
48kg480-500 mg/day (upper capped)
49kg490-500 mg/day (upper capped)
50kg500 mg/day (capped)
AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose 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.

Cautions
  • Azithromycin is an oral option for uncomplicated resistant Salmonella typhi.
  • There is a QT prolongation risk.
  • GI intolerance can occur at higher doses.
Egyptian brands
Egyptian brandManufacturerIndicative price
AZATRIBACT 500MG 3 CAPS.RIVA PHARMA S.A.E.13.50 EGP (4.50/unit)
GIGAZOCIN 500MG 5 CAPS.EGPI > PIONEER27.50 EGP (5.50/unit)
SYSTYMYCIN 500MG 3 CAPS.EGPI > NOVELL PHARMA21.50 EGP (7.17/unit)
AZITHROMASH 500 MG 3 F.C. TABS.MASH PREMIERE48.00 EGP (16.00/unit)
AZALIDE 500MG 3 CAPS.UP PHARMA52.00 EGP (17.33/unit)
AZROLID 500 MG 6 F.C.TABS.AMRIYA126.00 EGP (21.00/unit)
ZERAMERATE 500 MGEGPI > GAMMA PHARMA28.50 EGP
DISTABCIN 500 MG 3 DISPERSIBLE TABS.EGPI43.50 EGP
ZITHRODOSE 100MG/5ML SUSP. 15ML? strength differs? different route - not oral solidEL-OBOUR > AVERROES PHARMA-EGYPT12.00 EGP
ZITHROPHATE 200MG/5ML SUSP. 15ML? strength differs? different route - not oral solidORGANO PHARMA > NOVELL PHARMA12.75 EGP

SEVERE - INPATIENT

2

CEFTRIAXONE

Severe - inpatient

1st line

Strength1000 mg

Forminjection

Adult dose and duration

1-2 g IV once daily x 7-14 days

Paediatric dose

50-80 mg/kg/day [child max 2000 mg]

(IV once daily for 7-14 days)

Dose by weight
3kg150-240 mg/day
4kg200-320 mg/day
5kg250-400 mg/day
6kg300-480 mg/day
7kg350-560 mg/day
8kg400-640 mg/day
9kg450-720 mg/day
10kg500-800 mg/day
11kg550-880 mg/day
12kg600-960 mg/day
13kg650-1040 mg/day
14kg700-1120 mg/day
15kg750-1200 mg/day
16kg800-1280 mg/day
17kg850-1360 mg/day
18kg900-1440 mg/day
19kg950-1520 mg/day
20kg1000-1600 mg/day
21kg1050-1680 mg/day
22kg1100-1760 mg/day
23kg1150-1840 mg/day
24kg1200-1920 mg/day
25kg1250-2000 mg/day
26kg1300-2000 mg/day (upper capped)
27kg1350-2000 mg/day (upper capped)
28kg1400-2000 mg/day (upper capped)
29kg1450-2000 mg/day (upper capped)
30kg1500-2000 mg/day (upper capped)
31kg1550-2000 mg/day (upper capped)
32kg1600-2000 mg/day (upper capped)
33kg1650-2000 mg/day (upper capped)
34kg1700-2000 mg/day (upper capped)
35kg1750-2000 mg/day (upper capped)
36kg1800-2000 mg/day (upper capped)
37kg1850-2000 mg/day (upper capped)
38kg1900-2000 mg/day (upper capped)
39kg1950-2000 mg/day (upper capped)
40kg2000 mg/day (capped)
41kg2000 mg/day (capped)
42kg2000 mg/day (capped)
43kg2000 mg/day (capped)
44kg2000 mg/day (capped)
45kg2000 mg/day (capped)
46kg2000 mg/day (capped)
47kg2000 mg/day (capped)
48kg2000 mg/day (capped)
49kg2000 mg/day (capped)
50kg2000 mg/day (capped)
AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
ZOXIDEL 1 GM PD. FOR I.M. INJ.RAMEDA > DELTA PHARMA22.00 EGP
CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA)KAHIRA29.00 EGP
ZOXIDEL 1 GM PD. FOR I.V. INJ.RAMEDA > DELTA PHARMA29.00 EGP
WINTRIAXONE 1 GM PD. FOR I.V INJ.SANOFI48.00 EGP
VOTRIAXONE 1 GM I.M VIALCHEMIPHARM56.00 EGP
OFRAMAX 1 GM I.M. VIALRAMEDA > SUN PHARMA EGYPT LIMITED71.00 EGP
TRIAXONE 1 GM I.M. VIALTABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA106.00 EGP
TRIAXONE 1 GM I.V VIALTABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA106.00 EGP

MAIN TREATMENT - choose one, plus any add-on marked below

3

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose 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.

Cautions
  • 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

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg BID x 7-14 days

Paediatric dose

Reserve for pediatric cases where benefits outweigh joint risks

AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
QUINOLOROX 500MG 10 F.C. TAB.EPCI > ROXXEN10.00 EGP (1.00/unit)
ECACIPROFLOX 500 MG 20 F.C. TABS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > EGYPTIAN CANADIAN PHARMACEUTICAL27.00 EGP (1.35/unit)
ELMODOXACIN 500MG 10 F.C.TAB.EGPI > SEA PHARM20.00 EGP (2.00/unit)
CIPROQUIN 500MG 10 F.C. TAB.UNIPHARMA50.00 EGP (5.00/unit)
CIPROFLOXACIN-ORGANO 500 MG 10 F.C.TABS.ORGANOPHARMA > ORGANO63.00 EGP (6.30/unit)
CIPROFAR 500MG 10 F.C.TAB.PHARCO69.00 EGP (6.90/unit)
CIPROMEGA XL 500MG 10 EXT. REL. F.C.TABS.MASH PREMIERE48.00 EGP
HEROXACIN 500MG 10 SCORED F.C. TAB.EGPI > HERO PHARM69.00 EGP
5

DEXAMETHASONE

add-on - not a substitute

Strength4 mg

Forminjection

Adult dose and duration

Oral, IV, IM: 4 to 20 mg/day given in a single daily dose or 2 to 4 divided doses

Paediatric dose

Child: 0.15 to 0.6 mg/kg (max 16 mg) once daily.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
F-CORTEN 4MG/ML 3 AMPS.MEMPHIS12.00 EGP
EPIDRON 4MG/ML VIAL 2 MLEIPICO13.00 EGP

ORAL ALTERNATIVE TO CEFTRIAXONE

6

CEFIXIME

Oral alternative to ceftriaxone

2nd line

Strength200 mg

Formoral.solid

Adult dose and duration

400 mg daily, divided every 12 to 24 hours

Paediatric dose

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.)

Dose by weight
3kg24 mg/day
4kg32 mg/day
5kg40 mg/day
6kg48 mg/day
7kg56 mg/day
8kg64 mg/day
9kg72 mg/day
10kg80 mg/day
11kg88 mg/day
12kg96 mg/day
13kg104 mg/day
14kg112 mg/day
15kg120 mg/day
16kg128 mg/day
17kg136 mg/day
18kg144 mg/day
19kg152 mg/day
20kg160 mg/day
21kg168 mg/day
22kg176 mg/day
23kg184 mg/day
24kg192 mg/day
25kg200 mg/day
26kg208 mg/day
27kg216 mg/day
28kg224 mg/day
29kg232 mg/day
30kg240 mg/day
31kg248 mg/day
32kg256 mg/day
33kg264 mg/day
34kg272 mg/day
35kg280 mg/day
36kg288 mg/day
37kg296 mg/day
38kg304 mg/day
39kg312 mg/day
40kg320 mg/day
41kg328 mg/day
42kg336 mg/day
43kg344 mg/day
44kg352 mg/day
45kg360 mg/day
46kg368 mg/day
47kg376 mg/day
48kg384 mg/day
49kg392 mg/day
50kg400 mg/day
AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
VIODRILNEX 200 MG 21 CAPS.SIGMA TEC > HOCHSTER PHARMACEUTICAL INDUSTRIES69.00 EGP (3.29/unit)
CEFABRUM 200MG 8 TAB.ALFACURE PHARMACEUTICALS38.00 EGP (4.75/unit)
XIMACEF 200 MG 8 CAPSULESIGMA42.00 EGP (5.25/unit)
HEBIXIME 200MG 8 CAPS.SHIFA MEDICAL PRODUCTS > GLORY MEDICAL48.00 EGP (6.00/unit)
CEFALOTRIGENEX 200MG 8 F.C. TABS.SHIFA MEDICAL PRODUCTS > NALI PHARMA INTERNATIONAL66.50 EGP (8.31/unit)
SUPRAX 200 MG 8 CAPS.KAHIRA > HIKMA PHARMA138.00 EGP (17.25/unit)
VIODRILNEX 100MG/5ML SUSP. 30ML? strength differs? different route - not oral solidBADR PHARMA > HOCHSTER PHARMACEUTICAL INDUSTRIES21.50 EGP
CEFABRUM 100MG/5ML SUSP. 60ML? strength differs? different route - not oral solidALFACURE PHARMACEUTICALS27.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.