Uganda guidelines for the treatment of Typhoid Fever

Clinical Features

Insidious onset of sustained fever (39–40°C). Headache, malaise. Relative bradycardia (pulse lower than expected for fever). Rose spots (faint rash on trunk). Constipation or diarrhoea. Splenomegaly, hepatomegaly. Week 3+: Complications — intestinal perforation, haemorrhage, toxic encephalopathy.

Investigations

Blood culture (most sensitive in first 2 weeks — gold standard). Widal test (>1:160 titre suggestive, interpret with care in endemic area). Stool and urine culture (weeks 2–3). FBC: relative leucopenia.

First Line (Uncomplicated, HC2)

Chloramphenicol 500 mg every 6 hours for 14 days. Child: 25 mg/kg per dose every 6 hours for 10–14 days.

Alternative / Resistant Cases (HC3/HC4)

Ciprofloxacin 500 mg every 12 hours for 14 days. Child: 10–15 mg/kg twice daily (not for <12 years if alternative available). OR Azithromycin 500 mg once daily for 7 days.

Severe / Complicated Typhoid (HC4)

Ceftriaxone 2 g IV once daily for 14 days. Child: 100 mg/kg once daily.

Supportive Care

Adequate hydration and nutrition. Antipyretics (paracetamol) for fever. IV fluids if unable to tolerate oral intake. Blood transfusion if haemorrhage. Surgical management of intestinal perforation.

Prevention

Safe water supply and food hygiene. Hand hygiene after toilet and before food. Typhoid vaccine for high-risk populations and travellers. Report to public health authority.