Antibiotics should be given for thyroid fever

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Antibiotics for Typhoid Fever (Enteric Fever)

Note on terminology: "Thyroid fever" is not a recognized medical condition. You are most likely referring to typhoid fever (enteric fever), caused by Salmonella typhi or S. paratyphi. Antibiotics are absolutely the cornerstone of its treatment.

Why Antibiotics Are Required

Typhoid fever is a systemic bacterial infection. Without antibiotic treatment, mortality was historically as high as 10-15% and even up to 30% in some series. With appropriate antibiotic therapy, mortality falls to approximately 1%. Antibiotics also reduce the risk of complications like intestinal hemorrhage and perforation.

Antibiotic Choices

For Uncomplicated Typhoid Fever

Susceptibility	First-line Antibiotic	Dose	Duration	Alternatives
Fully sensitive	Fluoroquinolone (ciprofloxacin or ofloxacin)	15 mg/kg/day	5-7 days	Chloramphenicol 50-75 mg/kg/day x14-21d; Amoxicillin 75-100 mg/kg/day x14d; TMP-SMX 8-40 mg/kg/day x14d
Multidrug resistant (MDR)	Fluoroquinolone OR Cefixime	15 mg/kg/day	7-10d	Azithromycin
Fluoroquinolone resistant	Azithromycin or Ceftriaxone	-	10-14 days	-

(Park's Textbook of Preventive and Social Medicine, Table 1; Sleisenger & Fordtran GI, Table 110.8)

For Severe Typhoid Fever

Ceftriaxone 2 g IV once or twice daily x 10-14 days is the preferred parenteral agent
Ciprofloxacin 500 mg twice daily x 7-10 days (if susceptible)
Add dexamethasone (8 mg/kg x1, then 1 mg/kg every 6 hours x48 hours) in patients with delirium, obtundation, shock, or suspected typhoid meningitis/encephalitis - this significantly reduces mortality in severe disease
IV rehydration and blood transfusion as supportive measures

(Yamada's Textbook of Gastroenterology; Tintinalli's Emergency Medicine; Sleisenger & Fordtran)

Important Resistance Warnings

Fluoroquinolone resistance is increasing, especially in travelers returning from South and Southeast Asia (associated with nalidixic acid-resistant S. typhi)
Ampicillin, TMP-SMX, and chloramphenicol are now unreliable in many regions due to widespread resistance (multidrug-resistant typhoid)
In areas/cases of high fluoroquinolone resistance, azithromycin (1 g/day x 5 days) or ceftriaxone are preferred

(Tintinalli's Emergency Medicine; Sleisenger & Fordtran GI, p. 2197)

Antibiotic Treatment for Carriers

Chronic carriers (who harbor the organism in the gallbladder/biliary tract) are treated with:

Ampicillin or amoxicillin (4-6 g/day) + probenecid (2 g/day) for 6 weeks - eradicates the carrier state in ~70%
Cholecystectomy may be required in some carriers with gallbladder disease
Chloramphenicol is NOT effective for clearing the carrier state

(Park's Textbook of Preventive and Social Medicine)

Summary

Yes - antibiotics are mandatory for typhoid fever. Fluoroquinolones (ciprofloxacin/ofloxacin) remain the drug of choice where strains are still susceptible. For MDR strains, cefixime or azithromycin are used orally; ceftriaxone is used parenterally for severe cases. Dexamethasone is added only for severe/complicated cases with neurological involvement or shock.

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