Typhoid Treatment Calculator — Nigeria · Kenya · Ghana · India · Pakistan
Weight-based dosing for ceftriaxone, azithromycin, ciprofloxacin, chloramphenicol.
WHO 2018 + local resistance pattern guidance. Paediatric and adult. Offline-capable.
For qualified healthcare professionals only.
Doses sourced from WHO Guidelines on the Treatment of Typhoid Fever (2018) and national AMR surveillance data for each country.
Resistance patterns vary by region — always send blood/stool cultures where possible.
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Typhoid fever remains endemic across sub-Saharan Africa and South Asia, with an estimated 11–21 million cases and 128,000–161,000 deaths annually. Nigeria, Kenya and Ghana all have high typhoid endemicity driven by poor water sanitation and food hygiene. Pakistan, India and Bangladesh report the highest burden in South Asia. Multidrug-resistant (MDR) typhoid — resistant to ampicillin, chloramphenicol, and cotrimoxazole — is now prevalent across Africa and South Asia. Extensively drug-resistant (XDR) typhoid, first identified in Sindh Province, Pakistan in 2016, has since spread across South Asia and cases have been reported in East Africa. This calculator reflects WHO typhoid management guidelines and current published resistance patterns for Nigeria, Kenya, India and Pakistan.
For uncomplicated susceptible typhoid: ciprofloxacin 15 mg/kg/dose twice daily for 7–10 days (adult: 500–750 mg BD). For MDR typhoid (resistant to ampicillin, chloramphenicol, cotrimoxazole): azithromycin 20 mg/kg/day (adult: 1g/day) for 5–7 days, or cefixime 15–20 mg/kg/day (adult: 400 mg/day). For severe typhoid requiring IV: ceftriaxone 60–80 mg/kg/day (adult: 2g/day).
Extensively drug-resistant (XDR) typhoid is resistant to all first-line antibiotics (ampicillin, chloramphenicol, cotrimoxazole, fluoroquinolones) and third-generation cephalosporins. Azithromycin remains active against most XDR strains. XDR typhoid has been confirmed in travellers returning to Kenya and East Africa. Any typhoid not responding to ceftriaxone in a traveller from Pakistan or India should raise XDR concern.
Susceptible strains: 7 days ciprofloxacin or 5 days azithromycin. MDR: 5–7 days azithromycin or 7–14 days ceftriaxone IV. XDR: azithromycin 7 days (check local susceptibility). Severe or complicated typhoid (intestinal perforation, encephalopathy): 14 days IV ceftriaxone. Dexamethasone 3 mg/kg loading then 1 mg/kg every 6 hours for 48 hours for typhoid encephalopathy.
For a child with typhoid who cannot tolerate oral therapy, IV ceftriaxone is the drug of choice: 60–80 mg/kg/day IV once daily (maximum 4 g/day) for 10–14 days. If ceftriaxone is unavailable, IV ampicillin 200 mg/kg/day can be used for susceptible strains. Once the child can tolerate oral medication and fever is resolving, step-down to oral azithromycin or ciprofloxacin based on local susceptibility data. Ciprofloxacin should be avoided in children under 2 years and used only when the benefit clearly outweighs the risk due to arthropathy concerns, though WHO permits its use in severe enteric fever.
Complications requiring urgent senior review in typhoid fever include: intestinal perforation (sudden peritonism, board-like abdomen, free air on erect CXR — surgical emergency); intestinal haemorrhage (bright red rectal bleeding, haemodynamic instability); encephalopathy (altered consciousness, seizures — typhoid meningismus); hepatitis (jaundice, elevated transaminases — reduce antibiotic dose or switch); myocarditis (chest pain, ECG changes); haemophagocytic lymphohistiocytosis (persistent fever, pancytopenia, elevated ferritin); and septic shock. Perforation carries 10–32% mortality in sub-Saharan Africa — early surgical consultation is critical.
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For broader empirical antibiotic guidance across other infections, use the Antibiotic Selector.
📋 Guideline basis: WHO Typhoid 2011 · FMOH Nigeria · BNFc 2024 · Last reviewed: January 2025 · Next review due: January 2026 · Disclaimer · Report an error
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