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Enteric Fever — SCE Infectious Diseases MCQ

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ModerateTropical & Imported InfectionsEnteric FeverSCE Infectious Diseases

A 24-year-old woman returns from a 3-month backpacking trip across South-East Asia. She presents with 10 days of fever, hepatosplenomegaly, relative bradycardia, and a blanching maculopapular rash on the trunk. Blood cultures grow a Gram-negative bacillus identified as Salmonella enterica serovar Typhi. Sensitivity testing shows the organism is resistant to Nalidixic acid. What is the most appropriate treatment?

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Correct answer: A — Azithromycin 500 mg once daily for 7 days

Nalidixic acid resistance in S. Typhi is a marker for decreased fluoroquinolone susceptibility (DCS), which is common in South-East Asian isolates. Ciprofloxacin should not be used for DCS strains as clinical failure rates are high. Azithromycin is the recommended oral treatment for uncomplicated enteric fever with DCS. IV Ceftriaxone is reserved for complicated/severe disease. Chloramphenicol, although historically used, is no longer first-line.

Reference: UKHSA 2022 – Management of enteric fever; WHO 2019 – Guidelines on typhoid