TYPHOID FEVER;-
It is caused by Salmonella typhi and Salmonella paratyphi. Salmonella typhi causes a variety of illnesses including asymptomatic carrier state, gastro-enteritis and enteric fever.
Salient features:-
- The onset of fever is typically gradual, continuous (temperature upto 40º C) constitutional symptoms such as malaise, anorexia, lethargy, headache.
- Constipation or diarrhea (pea-soup stools) which may be associated with abdominal pain and tenderness.
- Hepatomegaly and splenomegaly may be observed.
Complications such as hepatitis, meningitis, pneumonitis and myocarditis can occur after the first week
Investigations:-
Diagnosis is suggested by Rising of O antibodies (Widal test) and Confirmed by isolation of organism in blood, bone marrow, urine or stool
Pharmacological treatment:-
- Most patients with uncomplicated enteric fever can be managed at home with oral antibiotics and antipyretics
- Patients with persistent vomiting, diarrhea, and/or abdominal distension should be hospitalized and given supportive therapy as well as a parenteral third-generation cephalosporin or fluoroquinolone, depending on the susceptibility profile
- Therapy should be administered for at least 10 days or for 5 days after fever resolution
Dosage schedule of antibiotics in treatment of typhoid fever:-
| Indication | Agent | Dosage (Route) | Duration, Days |
| Empirical Treatment | Ceftriaxonea | 1-2 g/d IV | 7–14 |
| Fully Susceptible | Ciprofloxacinb (first line) | 500 mg BD (PO) or 400 mg BD (IV) | 5–7 |
| Amoxicillin (second line) | 1 g TDS (PO) or 2 g QID (IV) | 14 | |
| Chloramphenicol | 25 mg/kg TDS (PO or IV) | 14-21 | |
| Trimethoprim-sulfamethoxazole | 160/800 mg BD (PO) | 7-14 | |
| Ciprofloxacin | 500 mg BD (PO) or 400 mg BD (IV) | 5-7 | |
| Multidrug-Resistant | Ceftriaxone | 2–3 g/day (IV) | 7-14 |
| Azithromycin | 1 g/day (PO)c | 5 | |
| Ceftriaxone | 2–3 g/d (IV) | 7-14 | |
| Azithromycin | 1 g/d (PO) | 5 | |
| Nalidixic Acid– Resistant | High-dose ciprofloxacin | 750 mg bid (PO) or 400 mg q8h (IV) | 10-14 |
aOr another third-generation cephalosporin [e.g., cefotaxime, 2 g TDS (IV); or cefixime, 400 mg bid (PO)]
bOr ofloxacin 400 mg bid (PO) for 2–5 days
cOr 1 g on day 1 followed by 500 mg/day PO for 6 days
- The 1–5% of patients who develop chronic carriage of Salmonella can be treated for 4–6 weeks with an appropriate oral antibiotic
- Treatment with oral amoxicillin, cotrimoxazole, ciprofloxacin, or norfloxacin is 80% effective in eradicating chronic carriage of susceptible organisms
- However, in cases of anatomic abnormality (e.g., biliary or kidney stones), eradication often requires both antibiotic therapy and surgical correction