Typhoid Fever

You catch typhoid by swallowing the bacteria in contaminated food or drink, for example unsafe water, ice made from unsafe water, raw or undercooked foods washed in unsafe water, or food handled by someone who carries the bacteria. It is not spread by coughing or casual contact. Poor hand-washing, unsafe water and inadequate sanitation allow it to spread.

Typhoid is far less common in places with safe water, good sanitation and food hygiene. It remains more common in regions where these are limited, and travellers to such regions and people exposed to contaminated food or water are at higher risk. Children are often affected.

Pilgrims and other travellers to and from regions where typhoid is more common may be at risk. If you travel for Hajj, Umrah, work or family visits, speak to your doctor or a travel clinic before you go about vaccination and food and water precautions. If you develop a fever after returning, tell your doctor where you travelled.

Diagnosis depends on finding the bacteria. A blood culture, taken before antibiotics are started when possible, is the most useful test early in the illness. Stool or urine cultures and bone marrow cultures are sometimes used, and blood tests may show a low white blood cell count or raised liver enzymes. Some blood antibody tests are used in certain places but are less reliable. Doctors also consider other causes of prolonged fever, such as malaria, other infections or typhus. Your doctor decides which tests you need, and the result guides the choice of antibiotic.

Suspected typhoid needs medical assessment, not home treatment. Hygiene also protects others.

• See a doctor promptly for a fever lasting more than a few days, and straight away for a baby or child who looks very unwell

• Wash hands thoroughly with soap and water after using the toilet, changing nappies and before preparing or eating food

• Avoid preparing food for others while ill, and until your doctor says it is safe

• Rest, and do not return to work or school until your doctor allows it, particularly if you handle food or care for others

• Do not take leftover or unprescribed antibiotics

Safe food and water are the key to prevention, and fluids matter during illness.

• Drink plenty of safe fluids; use oral rehydration solution for diarrhoea or vomiting, as advised

• When travelling to higher-risk areas, drink bottled or properly boiled or treated water, and avoid ice of unknown source

• Eat food that is freshly cooked and served hot; avoid raw salads and unpeeled fruit washed in unsafe water

• Choose pasteurised dairy products, and avoid food from street vendors if hygiene is uncertain

• Continue feeding babies (breast milk or formula) and children as advised by their doctor

Typhoid needs antibiotics chosen by a doctor, using culture and local resistance information.

• Take the antibiotic exactly as prescribed and finish the whole course, even if you feel better

• Severe cases are treated in hospital with intravenous antibiotics and fluids

• Fever and pain relief should be chosen with your doctor, and for children only with medical advice

• Tell your doctor if you are pregnant or breastfeeding, because the choice of antibiotic may differ

• Report if fever does not settle in the days after starting treatment; the antibiotic may need to be changed

Most people need no procedure, but complications may require one.

• Surgery is needed if the bowel perforates

• Blood transfusion or endoscopic treatment may be needed for significant bowel bleeding

• Hospital care with fluids and monitoring is used for more serious illness

• For long-term carriers, further tests or, rarely, gallbladder removal may be discussed by specialists

Some typhoid bacteria have become resistant to commonly used antibiotics, so the choice of antibiotic is guided by culture and sensitivity results and by local resistance patterns. Typhoid vaccines are available and are recommended for travellers to higher-risk regions and for people at ongoing risk; they do not give complete protection, so food and water precautions still matter.

With early and appropriate antibiotic treatment most people recover, though recovery can take weeks and tiredness may linger. Without treatment, or if treatment is delayed, the illness can become severe with complications such as bowel bleeding or perforation. A small number of people continue to carry the bacteria after recovery and can pass it on to others, so follow-up stool tests may be advised, especially for people who handle food.

• Do I have typhoid or another cause of fever, and which tests do I need?

• Can I be treated at home or do I need to be admitted?

• How long should I take the antibiotic and what should I do if the fever does not settle?

• When can I return to work or school, and do I need follow-up stool tests?

• Should my family be checked or vaccinated?

• What vaccination and food and water precautions do you advise before I travel?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.