Q: What is the empiric antibiotic of choice for suspected typhoid in 2026?

Due to widespread fluoroquinolone resistance (particularly in South Asia), azithromycin (500 mg daily for 7 days for uncomplicated disease) or ceftriaxone (2 g daily IV for 10–14 days for severe disease) are recommended. First-generation fluoroquinolones should not be used for empiric therapy unless the isolate is confirmed susceptible.

Q: What complications require surgical referral?

Intestinal perforation (sudden worsening of abdominal pain, guarding, rebound tenderness, pneumoperitoneum on imaging) is the most common surgical complication, occurring in 1–3% of hospitalised patients, typically in the third week of untreated illness.

Question 1

Which diagnostic test should I use if blood culture is negative?

Accepted Answer

Blood culture sensitivity is ~40–60% in the first week and declines to <30% after the first week. Bone marrow culture has higher sensitivity (~80%) and remains positive even after antibiotic initiation. The Widal test has limited sensitivity and specificity and should not be used alone.

Question 2

What is the empiric antibiotic of choice for suspected typhoid in 2026?

Accepted Answer

Due to widespread fluoroquinolone resistance (particularly in South Asia), azithromycin (500 mg daily for 7 days for uncomplicated disease) or ceftriaxone (2 g daily IV for 10–14 days for severe disease) are recommended. First-generation fluoroquinolones should not be used for empiric therapy unless the isolate is confirmed susceptible.

Question 3

What complications require surgical referral?

Accepted Answer

Intestinal perforation (sudden worsening of abdominal pain, guarding, rebound tenderness, pneumoperitoneum on imaging) is the most common surgical complication, occurring in 1–3% of hospitalised patients, typically in the third week of untreated illness.