Herbal Formulation Approaches in the Management of Typhoid Fever: A Comprehensive Review

Abstract

Typhoid fever, caused by Salmonella typhi and Salmonella paratyphi, remains a significant infectious disease in developing regions where poor sanitation persists.[1] The rapid emergence of multidrug-resistant (MDR) strains has reduced the efficacy of conventional antibiotics, prompting interest in herbal alternatives.[4] Medicinal plants such as Azadirachta indica (Neem), Ocimum sanctum (Tulsi), Tinospora cordifolia (Giloy), Andrographis paniculata (Kalmegh), Curcuma longa (Turmeric), and Zingiber officinale (Ginger) exhibit antimicrobial, antioxidant, and immunomodulatory activities effective against Salmonella species.[5] These phytochemicals act by inhibiting bacterial growth, modulating host immunity, and reducing oxidative stress.[3] To enhance patient compliance and bioavailability, effervescent granule formulations of herbal extracts offer a novel delivery platform characterized by rapid solubility, pleasant taste, and improved stability.[6] Evaluation parameters include effervescence time, pH, dissolution rate, and stability. However, standardization, variability of phytochemical content, and microbial contamination remain challenges.[2] Future studies should focus on clinical validation, optimization of effervescent formulation techniques, and regulatory standardization to ensure the safety, efficacy, and affordability of herbal effervescent products for typhoid fever management.

Introduction

Typhoid fever is a severe systemic infection caused mainly by Salmonella enterica serovar Typhi and Paratyphi, transmitted through contaminated food and water. It remains a major public health challenge in developing countries with poor sanitation, causing over 21 million infections and nearly 200,000 deaths annually.

Traditionally, treatment relies on antibiotics such as chloramphenicol, ampicillin, ciprofloxacin, and ceftriaxone, but the rise of multidrug-resistant (MDR) Salmonella strains has reduced their effectiveness, prompting the search for alternative therapies.

Herbal medicine offers promising solutions due to the antibacterial, antioxidant, antipyretic, and immune-boosting properties of plants like Neem (Azadirachta indica), Tulsi (Ocimum sanctum), Turmeric (Curcuma longa), Ginger (Zingiber officinale), Garlic (Allium sativum), and Giloy (Tinospora cordifolia). These herbs can inhibit bacterial growth, modulate immunity, and support organ function, making them potential alternatives for managing typhoid infection.

Modern research is focusing on effervescent herbal formulations, which improve solubility, taste, bioavailability, and patient compliance, especially beneficial for patients with nausea or poor appetite. Despite their potential, standardization, quality control, and optimization of effervescent reactions remain challenges.

Pathophysiologically, S. Typhi enters the intestine, invades macrophages, and spreads systemically via the bloodstream, affecting the liver, spleen, bone marrow, and intestines. The infection triggers inflammation, fever, and in severe cases, intestinal ulceration and perforation. Key virulence factors like the Vi antigen enable immune evasion and chronic infection.

Current antibiotic therapies include fluoroquinolones (ciprofloxacin, ofloxacin), third-generation cephalosporins (ceftriaxone, cefixime), and macrolides (azithromycin), with carbapenems and tigecycline used for extensively drug-resistant strains. Supportive care remains essential.

In conclusion, combining herbal therapeutics with innovative effervescent delivery systems could offer an effective, patient-friendly, and sustainable strategy for treating typhoid fever while addressing the challenges of antibiotic resistance and drug efficacy.

Conclusion

Typhoid fever continues to pose a significant threat in developing countries due to poor sanitation and the emergence of multidrug-resistant Salmonella typhi strains. While antibiotics remain the mainstay of therapy, the escalating resistance crisis necessitates exploration of safer, sustainable alternatives. Herbal medicine provides a promising adjunct or substitutes due to its broad pharmacological properties, including antibacterial, antioxidant, immunostimulant, and hepatoprotective actions. Plants such as Azadirachta indica, Curcuma longa, Zingiber officinale, Tinospora cordifolia, and Ocimum sanctum exhibit potent antimicrobial activity against Salmonella species and aid in immune modulation and recovery. Recent formulations, including effervescent herbal granules, enhance patient compliance, bioavailability, and acceptability while maintaining stability and rapid dissolution. However, limitations such as lack of standardization, microbial contamination, dosage inconsistency, and limited clinical validation hinder widespread acceptance. To advance herbal therapy in typhoid management, integration of modern formulation strategies, such as effervescent technology and quality-controlled extraction, is crucial. Future research should emphasize bioactive compound isolation, pharmacokinetic profiling, toxicological evaluation, and multicentric clinical trials.

References

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Copyright

Copyright © 2025 Mauli Gawade, Sakshi Girme , Amol Ghane , Pratap Hirwe , Kashish Ghosalkar , Reshma Dhakate . This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.