## Antibiotic Management of Enteric Fever in Children **Key Point:** Third-generation cephalosporins (ceftriaxone or cefixime) are now the first-line agents for enteric fever in children in India due to widespread resistance to older agents. ### Evolution of Antimicrobial Resistance | Drug Class | Historical Use | Current Status in India | Reason for Change | |------------|----------------|------------------------|-------------------| | Chloramphenicol | First-line (1950s–1980s) | Obsolete | High resistance (>80%), bone marrow toxicity | | Trimethoprim-sulfamethoxazole | First-line (1980s–1990s) | Not recommended | Widespread resistance (>50%) | | Fluoroquinolones | First-line (1990s–2000s) | Limited use | Increasing resistance, especially in North India | | Third-generation cephalosporins | Emerging (2000s) | **Current first-line** | Low resistance rates, excellent CNS penetration | **High-Yield:** The emergence of multidrug-resistant (MDR) Salmonella typhi and extensively drug-resistant (XDR) strains has necessitated a shift toward cephalosporins. Ceftriaxone is preferred for severe/complicated cases and meningitis; cefixime is used for uncomplicated cases. ### Dosing in Children - **Ceftriaxone:** 50–80 mg/kg/day in 2 divided doses IV/IM (max 2 g/day) - **Cefixime:** 8–10 mg/kg/day in 2–3 divided doses orally - **Duration:** 7–14 days depending on severity **Clinical Pearl:** Fluoroquinolones (ciprofloxacin) are increasingly avoided in children due to resistance and theoretical concerns about cartilage toxicity, though they may be considered in older adolescents with uncomplicated disease and documented susceptibility. **Warning:** Chloramphenicol and TMP-SMX should NOT be used as first-line agents in current practice due to high resistance rates and toxicity concerns.
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.