Treatment of Typhoid or Enteric Fever

General

  1. Fluids and electrolytes may be given through a vein (intravenously)
  2. Drinking a lot of uncontaminated water with electrolyte packets.

Specific Treatment

Appropriate antibiotics are given to kill the bacteria. There are increasing rates of antibiotic resistance throughout the world, so your health care provider will check current recommendations before choosing an antibiotic. Several antibiotics are effective in enteric fever.

Ciprofloxacin in a dose of 500 mg  12-hourly is drug of choice. It is a fluroquinol Derivate

 Adverse Drug Related events:

The most frequently reported drug related events were

  1. Nausea                ii.Diarrhea                    iii.        liver function tests abnormal
  2. vomiting            v.         rash

Alternative

  1. Alternative includes Co-trimoxazole (two tablets 400mg of sulpamethoxazole and 80 mg of trimethoprim) 12 hourly).
  2. Injection Co-trimoxazole  I/M (intramuscular) ,5ml thrice
  3. Injection Co-TrimoxazoleIntravenous 10 ml diluted and  infused twice  daily
  4. Pediatrics suspension
  5. under six weeks not recommended
  6. 6 weeks to 5 month 2.5 m              (all twice daily)

iii.        Over 6 years -10ml                        (all twice daily)

Major adverse drug reaction of Co-trimoxazole is

  1. Stevens-Johnson syndrome, toxic
  2. Epidermal necrolysis

iii.        Fulminant hepatic necrosis

  1. Agranulocytosis, aplastic anemia,
  2. Other blood dyscrasias

 

Resistance cases:

Increase in number of Salmonella, includes. S.typhi are now resistance to many antibiotics and some are only sensitive to Ciprofloxacin.

  1. a)    The  third  generations  under mentioned  antibiotics  are recommended when the  organisms  are resistance and  the treatment  to be continued for a period of fourteens days.:Cephalosporin. in a dose of 500 mg 12-hourly.

Adverse Reactions

  1. a)    It should be administer   with care to Pregnant and lactating mothers. b)    Nausea, c)    diarrhea , d)    liver function tests abnormal, e)    vomiting, f)      rash

Ceftriaxone. Dosage; 1-2 g IV/IMqDay or divided BID for 4-14 days depend on type and severity of  Infection. Use it with cautioned  controlled study has shown no fetal risk. Allergic reactionscan be Difficulty breathing or Swelling of your face, lips, Tongue  or throat

Cefotaxtime.

  1. Dosage: Mild to Moderate infection I/M,I/V   1-2 gms  8-12 hourly
  2. It should be administer with care to Pregnant and lactating mothers

 Adverse drug Reaction:

Between 1-10 %

  1. Fever        ii.        Rash       iii.        Pruritus       iv.        Colitis      v.        Diarrhea
  2. Nausea   vii.        Vomiting       viii.        Eosinophilia   ix.        Inj site pain

 

Chronic Carrier:

In case there is recrudescence of the disease and development of the of a carrier should  be  treated  for  a period  of  4 weeks with Ciprofloxacin; Cholecystectomy may be necessary in some  cases.

Prevention of Typhoid                                                                                   

General Measures

  • Water treatment
  • Waste disposal
  • Protecting the food supply from contamination are important public health measures

Specific Measures

  1. Carriers of typhoid must not be allowed to work as food handlers.
  2. Vaccines are recommended for travel outside
  3. During epidemic outbreaks.
  4. If you are traveling to an area where there is typhoid fever, you should bring electrolyte
  5. Packets in case you get sick.
  6. Immunization is not always completely effective and at-risk travelers should drink only   boiled or bottled water
  7. Eat well-cooked food.

When to Contact a Medical Professional

  1. Call your health care provider if:
  2. You have had any known exposure to typhoid fever
  3. You have been in an endemic area and you develop symptoms of typhoid fever
  4. You have had typhoid fever and the symptoms return
  5. You develop severe abdominal pain, decreased urine output, or other new symptoms
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