Top Typhoid Fever Antibiotics in Nigeria

Top Typhoid Fever Antibiotics in Nigeria – Typhoid fever is a serious public health issue in Nigeria with an estimated over 300,000 cases and over 30,000 deaths each year. The disease is transmitted by ingesting food or water contaminated with the feces or urine of an infected person. Symptoms of typhoid fever include high fever, headache, nausea, loss of appetite, constipation or diarrhea, and abdominal rash. Without prompt antibiotic treatment, complications like intestinal perforation, bleeding, confusion, and even death can occur.Top Typhoid Fever Antibiotics in Nigeria

The emergence of drug-resistant Salmonella Typhi strains in Nigeria poses treatment challenges. However, appropriate antibiotic therapy remains the mainstay for treating typhoid fever. The antibiotics work by killing the Salmonella Typhi bacteria or inhibiting their growth. This article provides a helpful guide to the top antibiotics commonly used for treating typhoid fever in Nigeria based on efficacy, availability, and affordability.

The Top Typhoid Fever Antibiotics in Nigeria are:

Ciprofloxacin

Ciprofloxacin is currently the first-line antibiotic for treating typhoid fever in Nigeria. It is a second-generation fluoroquinolone antibiotic that interferes with bacterial DNA replication and transcription, rapidly killing salmonella bacteria. Ciprofloxacin is available in oral (tablet) and intravenous formulations.JAMB portal

The recommended ciprofloxacin dose for adults is 500-750 mg twice daily for 5-7 days. It is tolerated well with mild side effects like nausea, diarrhea, and headache in some people. Ciprofloxacin offers high clinical success rates of over 90% in uncomplicated typhoid fever cases. It also leads to quick fever clearance and low likelihood of salmonella relapse.

However, ciprofloxacin resistance is an emerging problem in Nigeria. Resistance rates to ciprofloxacin among Salmonella Typhi isolates increased from 5% in 2005 to over 75% in 2019 in some regions. Hence, susceptibility testing is recommended before using ciprofloxacin for treating typhoid fever.

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Ceftriaxone

Ceftriaxone is a third-generation semi-synthetic cephalosporin antibiotic. It has a broad spectrum of activity against gram-negative bacteria like Salmonella Typhi. Ceftriaxone inhibits bacterial cell wall synthesis, rapidly killing the pathogens.

In Nigeria, ceftriaxone is commonly used for managing complicated and drug-resistant typhoid fever cases. It is administered intravenously once daily in a dose of 2 grams for 5-7 days. Ceftriaxone has shown excellent efficacy in ciprofloxacin-resistant typhoid fever with clinical success rates above 95%.

Ceftriaxone is also considered safe in pregnancy for treating typhoid fever. However, it is more expensive than ciprofloxacin. Rare side effects like gallbladder sludge have also been reported with ceftriaxone use. Overall, ceftriaxone remains a crucial second-line antibiotic option for treating typhoid fever in Nigeria.

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Azithromycin

Azithromycin is a macrolide antibiotic that is increasingly used for treating uncomplicated typhoid fever in Nigeria. It prevents salmonella growth by binding to bacterial ribosomes.Romantic love message

The recommended dose of azithromycin for typhoid fever is 500 mg to 1 gram given orally once daily for 5-7 days. Clinical studies conducted in Nigeria have reported cure rates of over 96% with azithromycin for typhoid fever.

Azithromycin has excellent intracellular penetration in tissues. It achieves high concentrations within macrophages where salmonella bacteria reside and replicate. This unique pharmacokinetic property contributes to its efficacy in typhoid fever.

Furthermore, azithromycin has a low rates of resistance among Salmonella Typhi strains in Nigeria currently. It does not have major drug interactions or contraindications either. Azithromycin is well-tolerated with mainly mild gastrointestinal side effects. Considering these advantages, azithromycin is endorsed as an inexpensive first-line oral antibiotic option for uncomplicated typhoid fever cases in Nigeria.Information guide Nigeri

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Ciprofloxacin (brand names Cipro, Cipro XR)

Ciprofloxacin is available under the brand names Cipro and Cipro XR in Nigeria. Cipro tablets contain 250 mg, 500 mg or 750 mg of ciprofloxacin. Cipro XR is an extended-release formulation containing 500 mg or 1000 mg of ciprofloxacin.

Cipro is usually prescribed at a dose of 500 mg twice daily for 7-14 days for treating typhoid fever. Cipro XR allows once daily dosing with 1000 mg for uncomplicated typhoid cases. Both tablet forms deliver high concentrations of ciprofloxacin systemically and within the gastrointestinal tract to eliminate salmonella bacteria.

However, Cipro or Cipro XR tablets should not be used for complicated typhoid fever cases like intestinal perforations or bleeding. Intravenous ciprofloxacin is preferred in such situations. With oral intake, the Cipro brand medications remain reliable and effective options for managing typhoid fever in Nigeria.

Azithromycin Dose Pack

Azithromycin dose pack refers to the 3-day course azithromycin formulation commonly used for treating typhoid fever in Nigeria. It contains 6 tablets with each tablet having 250 mg of azithromycin.

The recommended dosage schedule is 500 mg (2 tablets) orally once daily for 3 days. This 3-day azithromycin dose pack is convenient and improves adherence. It achieves therapeutic azithromycin concentrations within body cells and tissues where salmonella Typhi thrives.

Clinical studies in Nigeria have shown that the 3-day course of the azithromycin dose pack has equal efficacy as longer 5-7 day courses. It results in over 96% clinical cure rates, safe use in pregnancy, and low relapses. With short duration, good tolerability, and low cost, the 3-day azithromycin dose pack is considered one of the best first-line oral antibiotic options for managing uncomplicated typhoid fever cases in Nigeria.

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Ampicillin

Ampicillin is an aminopenicillin antibiotic historically used for treating typhoid fever. However, ampicillin resistance among Salmonella Typhi is high in Nigeria exceeding 60-80% in recent years. Hence, it is no longer recommended as an empirical therapy for typhoid fever in Nigeria.

Despite this, ampicillin may still be an option for typhoid fever cases if susceptibility is confirmed through laboratory testing. When sensitive, ampicillin given at 100 mg/kg/day dose in 4 divided doses for 10-14 days can help achieve clinical cure. But close monitoring is required as resistant subpopulations may emerge during treatment.Good morning My Love Message

Injection ampicillin formulations are also not optimal choices now for managing complications of typhoid fever in Nigeria considering the high resistance rates. Safer second-line injectable agents like ceftriaxone and imipenem are preferred currently over ampicillin for complicated typhoid fever cases in Nigeria.

Fluoroquinolones

Fluoroquinolone antibiotics like ciprofloxacin, ofloxacin and levofloxacin were previously extensively used for treating typhoid fever in Nigeria. However, fluoroquinolone resistance among Salmonella Typhi has risen dramatically from around 5% in 2003 to over 75% in some regions now.

Hence, empirical use of fluoroquinolones like ciprofloxacin for typhoid fever without susceptibility testing is not recommended in Nigeria anymore. Confirming sensitivity is crucial. If typhoid fever strains are fluoroquinolone-susceptible, agents like ciprofloxacin and ofloxacin remain very effective options at 500-750 mg twice daily dosing respectively.

Among fluoroquinolones, ciprofloxacin and ofloxacin have better efficacy than levofloxacin for typhoid fever per local studies. Besides bacterial resistance, caution with fluoroquinolones is also needed in children due to cartilage risks. Overall, fluoroquinolones can be used judiciously for typhoid fever in Nigeria but rising resistance is concerning.

Ciprofloxacin Intravenous (Cipro I.V)

Ciprofloxacin intravenous formulations are available in Nigeria under the brand name Cipro I.V. It contains 200 mg or 400 mg of ciprofloxacin in each 100 ml solution bag. Cipro I.V allows administering ciprofloxacin via slow intravenous infusion over 60 minutes.NYSC Portal

Cipro I.V is mainly used in hospitals for treating serious typhoid fever cases like toxic megacolon, intestinal bleeding or perforations. It provides immediate and predictable serum levels of ciprofloxacin for rapid bacterial killing. The dose is 400 mg 8-12 hourly based on severity.

Compared to oral ciprofloxacin, Cipro I.V allows giving higher doses without concerns about reduced gut absorption in complicated typhoid fever. Hence, Cipro I.V remains a crucial formulation and optimal choice for managing severe and resistant typhoid fever cases in healthcare facilities across Nigeria.

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Amoxicillin

Amoxicillin is a moderate spectrum aminopenicillin antibiotic. Historically it was used for treating typhoid fever. However, amoxicillin has very limited efficacy in Nigeria currently due to exceptionally high resistance rates up to 90-100% among Salmonella Typhi isolates.

It is no longer recommended for empirical treatment of typhoid fever. Even for culture-confirmed susceptible cases, clinical failures are common with amoxicillin. This is likely due to undetectable minor salmonella subpopulations that persist and propagate resistance.

For typhoid fever, amoxicillin has inferior efficacy compared to azithromycin, fluoroquinolones and third-generation cephalosporins in local comparative trials. Hence, amoxicillin use is best avoided altogether for typhoid fever cases in Nigeria irrespective of sensitivity reports due to concerns about treatment failure.

Conclusion

In conclusion, ciprofloxacin, ceftriaxone, and azithromycin are currently the most reliable first-line antibiotics for treating typhoid fever in Nigeria. Fluoroquinolones like ciprofloxacin and ofloxacin remain options for susceptible cases but resistance rates are worrisome. Other previously used antibiotics like ampicillin, amoxicillin, and chloramphenicol are no longer optimal choices.

With rising antimicrobial resistance, clinicians in Nigeria should exercise prudence and aim for culture-directed therapy for managing typhoid fever cases. Continued surveillance and stewardship are also crucial to preserve efficacy of currently effective antibiotics against Salmonella Typhi strains in Nigeria. Prompt treatment and preventive strategies also remain key to curbing the burden of typhoid fever.

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