Management of Enteric Fever
Diagnosis and Initial Assessment
- Blood cultures should be collected before starting antibiotics, as they have the highest yield within the first week of symptoms, according to the Journal of Infection 1, 2
- Stool and urine cultures become positive after the first week of illness, with lower sensitivity than blood cultures, as reported by the Journal of Infection 2
- Bone marrow cultures have higher sensitivity than blood cultures but are more invasive, as noted by the Journal of Infection 1, 2
Empiric Antibiotic Therapy
- The American College of Physicians recommends ceftriaxone 50-80 mg/kg/day (maximum 2g/day) IV for 5-7 days for hospitalized patients or severe illness, with treatment continued for 14 days to reduce risk of relapse, as suggested by Praxis Medical Insights 3, 4
- Azithromycin 20 mg/kg/day (maximum 1g/day) for 7 days is recommended for uncomplicated cases, with azithromycin showing lower risk of clinical failure compared to fluoroquinolones, according to Praxis Medical Insights 3, 4
Important Considerations
- Over 70% of S. typhi and S. paratyphi isolates imported to the UK are resistant to fluoroquinolones, as reported by the Journal of Infection 1, 2
- Patients with clinical features of sepsis should receive broad-spectrum antimicrobial therapy immediately after blood culture collection, as recommended by Clinical Infectious Diseases 5, 3
Monitoring and Complications
- Monitor for complications such as gastrointestinal bleeding, intestinal perforation, and typhoid encephalopathy, which occur in 10-15% of patients, as noted by the Journal of Infection 1, 2
- Complications are more likely if duration of illness exceeds 2 weeks, as reported by the Journal of Infection 2
Relapse Prevention and Follow-up
- Relapse rates are lower for ceftriaxone (<8%) and azithromycin (<3%) compared to fluoroquinolones, as reported by the Journal of Infection 2
- Treatment should be continued for 14 days to reduce risk of relapse, as suggested by the Journal of Infection 2