today morninig class Enteric fever mgt.pptx

enteric fever

1. Enteric fever Management

2. MANAGEMENT Symptomatic management Supportive management Specific management Manage complications

3. Symptomatic and Supportive MANAGEMENT Antipyretics – Paracetamol, Ibuprofen - Tap water sponging Hydration – Oral / IV fluids Nutrition – small frequent feeds -- Give usual diet which the child likes -- Do not stop roti or usual food -- No need to give soft diet if abdomen is not tender. -- Soft diet was needed in the past when specific treatment and antibiotics were not available

4. Antibiotics for Typhoid Fever Choice of Antibiotic for an infection depends upon Severity of illness Route of administration - Oral or IM or IV antibiotics Adverse effects of antibiotics Antibiotic Resistance (local resistance pattern) -- -- Inappropriate use of antibiotics promotes resistance ---- Anti-microbial resistance to bacteria is increasing

5. Antibiotics for different Types of Typhoid Fever Non-resistant Sensitive Typhoid Treated by Amoxycillin, Chloramphenicol and Co-trimoxazole Multi–drug resistant (MDR) typhoid - from 1990 onwards Salmonella typhi resistant to previously used antibiotics Sensitive to Ceftriaxone, Cefixime, Ciprofloxacin Extremely Drug Resistant (XDR) Typhoid – 2016 Salmonella typhi resistant to all previously used antibiotics Resistant to Amoxycillin, Cephalosporins, Quinolones Sensitive to Azithromycin and Carbapenems only

6. Specific management of Typhoid Fever Initial Treatment for MDR typhoid Ceftriaxone IV (50 – 75 mg/kg/d) for Treat for at least 7 days after defervescence or a total of 14 days, whichever is later OR Cefixime Oral (20 mg/kg/d) for 7- 10 days If no response – Treatment for XDR Typhoid Azithromycin Oral (20 mg/kg/d) for 5-7 days OR Imipenem / Meropenem IV (60 mg/kg/day)

7. Role of steroids Steroids are indicated only in severe illness. If the patient presents with shock, coma, or in altered sensorium, dexamethasone in the dose of 3 mg/kg followed by 1 mg/kg every 6 hours for 2 days may be given. Prolonged use of steroids can increase the relapse rate and cause adverse effects, hence use judiciously.

8. Relapse Recurrence of fever 2–3 weeks after its initial resolution is called relapse. It is usually milder. relapse rate of 5–20%. Treatment of relapse is with the same drug used for initial therapy Carrier state It is defined as an asymptomatic person who sheds Salmonella in stool or urine beyond 3 months of an episode of enteric fever If detected treat with trimethoprim-sulfamethoxazole (10 mg/kg/day for 6–12 weeks) or high dose amoxicillin (75–100 mg/kg/day for 4–6 weeks) to decrease the risk to close contacts.