A 7-year-old child presents with high-grade fever for 10 days, relative bradycardia, hepatomegaly, and rose spots on the trunk. Widal test: O titer 1:320, H titer 1:640. Blood culture pending. The most appropriate first-line antibiotic for this uncomplicated enteric fever in this child is:

• A Azithromycin ✓
• B Chloramphenicol
• C Ciprofloxacin
• D Ceftriaxone

Explanation

Azithromycin is the current first-line oral antibiotic for uncomplicated enteric fever caused by Salmonella Typhi in children due to widespread fluoroquinolone resistance (reduced susceptibility to ciprofloxacin) and multidrug resistance in many regions including South Asia. Azithromycin (20 mg/kg/day for 5–7 days) achieves high intracellular concentrations. Ciprofloxacin is no longer first-line given widespread reduced susceptibility. Ceftriaxone is the first-line choice for severe or complicated typhoid requiring IV therapy. Chloramphenicol is used only in MDR-susceptible strains and has significant side effects.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.