Curcumin Extract Added to Ciprofloxacin for Typhoid Carriers Among Food Handlers of the Free Nutritious Meal Program

Some people keep carrying Salmonella Typhi after they recover from typhoid fever. These carriers have no symptoms. They can still pass the bacteria into food. Food handlers in the Free Nutritious Meal Program (Makan Bergizi Gratis, MBG) cook for many school children every day. One carrier in an MBG kitchen can cause an outbreak. Standard antibiotics often fail to clear the carrier state. The bacteria form a biofilm on gallstones. This biofilm protects them from antibiotics. Curcumin is the main active compound of turmeric. In laboratory studies, curcumin weakens the biofilm. It may also help ciprofloxacin stay longer inside the bacteria. This study has two stages. In stage 1, the study team screens 100 MBG food handlers in Surakarta, Indonesia. Each person gives a blood sample for the Widal test. People with a high Widal titer give a rectal swab for culture. In stage 2, people with a positive Salmonella Typhi culture are randomly assigned to one of two groups. One group takes ciprofloxacin plus curcumin extract. The other group takes ciprofloxacin plus placebo. Treatment lasts 28 days. The main question is whether curcumin added to ciprofloxacin clears Salmonella Typhi better than ciprofloxacin alone. The main outcome is a negative rectal swab culture 30 days after treatment ends.