<P> Surgery is usually indicated in cases of intestinal perforation . Most surgeons prefer simple closure of the perforation with drainage of the peritoneum . Small - bowel resection is indicated for patients with multiple perforations . </P> <P> If antibiotic treatment fails to eradicate the hepatobiliary carriage, the gallbladder should be resected . Cholecystectomy is not always successful in eradicating the carrier state because of persisting hepatic infection . </P> <P> As resistance to ampicillin, chloramphenicol, trimethoprim - sulfamethoxazole, and streptomycin is now common, these agents have not been used as first--line treatment of typhoid fever for almost 20 years . Typhoid resistant to these agents is known as multidrug - resistant typhoid (MDR typhoid). </P> <P> Ciprofloxacin resistance is an increasing problem, especially in the Indian subcontinent and Southeast Asia . Many centres are shifting from using ciprofloxacin as the first line for treating suspected typhoid originating in South America, India, Pakistan, Bangladesh, Thailand, or Vietnam . For these people, the recommended first - line treatment is ceftriaxone . Also, azithromycin has been suggested to be better at treating typhoid in resistant populations than both fluoroquinolone drugs and ceftriaxone . Azithromycin significantly reduces relapse rates compared with ceftriaxone . </P>

When was the cure for typhoid fever discovered