Infectious

Enteric Fever (Typhoid)

ٹائیفائیڈ بخار

Gradual-onset, step-ladder, continuous fever with non-focal features. Blood culture is the gold standard; Typhidot and Widal have no role per the book.

ICD-10: —
Source: OPD handbook pp.77–80
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Fever: gradual in onset, step-ladder pattern, continuous (does not touch baseline)
Non-focal: may be dry cough, constipation

Diagnosis

Temperature 100–101 °F; pulse about 90/min (relative bradycardia)
Coated tongue
Abdomen: spleen may be palpable; rose spots
CBC: leukopenia (WBC under 4000), anaemia
Blood culture: gold standard
No role of Typhidot or Widal

Treatment

Step 1 of 4

1. Antibiotics

Ciprofloxacin: cipro is resistant per the book

Prescription

AzithromycinMacrolide antibiotic

DoseAdult 500 mg OD; paediatric 10 mg/kg

Brand Azitma / Arzomic / Zyto / Genthro

Also sold as Zithromax, Azomax, Azitma, Arzomic, Zyto, Genthro

Caution: QT prolongation; caution with other QT-prolonging drugs

Ceftriaxone3rd-generation cephalosporin

DoseAdult 1 g BD; paediatric 50 mg/kg divided into BD doses (usually 500 mg BD)

Brand Injectable ceftriaxone

Also sold as Rocephin, Dayline, Oxidil

Resistance is widespread in Salmonella Typhi in Sindh and Punjab; use culture guidance.

Cefixime3rd-generation cephalosporin

DoseAdult 400 mg BD; paediatric 10 mg/kg BD (the scan reads 'BI'; BD is assumed)

Brand Cefixime

Also sold as Cefspan, Cefim, Caricef, Tixomer, Cefiget

Rising resistance in Salmonella Typhi; not reliable as a sole agent in XDR typhoid.

CiprofloxacinFluoroquinolone antibiotic

DoseAdult 500 mg BD

Brand Cipro

Also sold as Novidat, Mercep, Cipro, Ciproxin, Ciprin

The book states cipro is resistant

Step 2 of 4

2. Antipyretics

Prescription

Paracetamol (Acetaminophen)Analgesic / antipyretic

Dose2+2+2

Brand Tab Panadol 500 mg

Also sold as Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL)

Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease

Paracetamol injectionAnalgesic / antipyretic

DoseTDS if indicated

Brand Inj Provas 1 g

Step 3 of 4

3. Appetizer

Prescription

Appetizer / multivitamin syrupAppetite stimulant / tonic

Dose2 tsf BD

Brand Syp Lysovit

Also sold as Trimetabol, Lysovit, Nesbol, T-Metabol

Step 4 of 4

4. Counselling (from the Urdu note)

Explain: you have typhoid fever, in which the intestines become inflamed; the fever settles in 5–7 days
Stop roti; use daliya, sago (sabudana) and khichdi
Take medicines regularly
In the sample prescription: if stomach pain or fever recurs, return at once

Sample prescription from the book (patient details removed)

Male, 40 y, fever 5 days, gradual onset, no cough; fever decreases but does not fully settle; coated tongue; T 101 °F, pulse 94. Plan: pass IV line; Inj Ceftriaxone 1 g. Rx: Inj Ceftriaxone 1 g in the evening; Tab Azitma 500 mg 1+0 daily for one week; Tab Panadol 500 mg 2 tabs if fever; Syp Lysovit 2+2 tsf. Stop roti; use daliya, sago, khichdi; take medicines regularly.