Management of Persistent Enteric Fever Despite Meropenem Therapy

Evaluation of Treatment Failure

Check for sequestered foci of infection that may require drainage, consider malabsorption of oral antibiotics, and rule out other concurrent infections in patients with enteric fever who have persistent fever despite 2 weeks of meropenem therapy, as recommended by the Centers for Disease Control and Prevention (CDC) 1
Drug susceptibility testing is crucial for guiding therapy in persistent cases, and patients with Salmonella bacteremia may remain febrile for 5-7 days despite effective therapy, requiring careful observation 1

Repeat blood cultures if fever persists beyond 7 days on new antimicrobial regimen, and evaluate for complications such as intestinal perforation or metastatic infections in patients with enteric fever 1
Evaluate for complications such as intestinal perforation or metastatic infections in patients with enteric fever 2

For recurrent Salmonella septicemia, consider 6 months or more of antibiotic treatment as secondary prophylaxis, especially in immunocompromised patients 1
Imaging studies may be needed to detect complications such as aortitis, mycotic aneurysms, or extra-vascular foci of infection in patients with enteric fever 3

Household contacts should be evaluated for asymptomatic carriage to prevent recurrent transmission, as recommended by the CDC 1
Avoid empiric switching of antibiotics without confirming susceptibility patterns, as recommended by the Infectious Diseases Society of America 2