From Antibiotics to Earthworms: A Literature Review on Conventional and Alternative Therapies for Typhoid Fever

Abstract

Typhoid fever remains a significant public health concern, particularly in developing countries like Indonesia. Conventional therapies relying on antibiotics now face major challenges due to the rising resistance of Salmonella typhi, including multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains. This growing resistance has prompted the search for alternative treatments derived from natural sources. Earthworms (Lumbricus rubellus) have emerged as promising candidates, demonstrating antipyretic, anti-inflammatory, antibacterial, and immunomodulatory properties in various in vivo studies. Bioactive compounds such as lumbrokinase and antimicrobial peptides found in earthworm extracts play a role in inhibiting the growth of S. typhi and enhancing immune responses. However, limited clinical data and variability in product quality remain key challenges. The integration of conventional antibiotic therapies with alternative treatments is considered a promising approach to developing more effective and sustainable strategies for managing typhoid fever. This article presents a comprehensive review of antibiotic-based conventional therapies as well as the exploration of alternative treatments, including phytotherapy, natural immunomodulators, and animal-based therapies such as the use of Lumbricus rubellus extracts. A multidisciplinary approach to typhoid treatment is essential, particularly in light of the increasing prevalence of MDR and XDR S. typhi. This review aims to provide an updated perspective on the development of effective, safe, and sustainable typhoid treatment strategies.