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How to manage typhoid fever?

Q: My elder brother is suffering from fever for the last two months. Nature and intensity of fever was not regular but for last one week his temperature rises upto 102 at night but not at day time. He got checked up and the doctor advised for blood tests (ESR, haemoglobin etc.) and sonography of full abdomen. Blood tests show ESR-52mm and haemoglobin 11.8g/dl. Ultrasound report suggested mild enlargement of liver. After looking at the reports, the doctor prescribed antibiotics and liver toner medicine. After using these medicines for 5 days his fever has come down to 99-100 and the appetite has improved. Since the fever was still persisting, doctor advised some more tests (SGPT, bilrubin and tests for typhoid). The Report suggested typhoid positive. The doctor is saying it is drug resistant typhoid and the treatment will take time. I wish to know what is drug resistant typhoid and whether correct treatment is being given? Is there any thing to worry?

A:You have not mentioned the tests done for typhoid and the medication prescribed. The investigations usually done for diagnosing typhoid fever include blood culture, urine culture, stool culture, serum widal test (serology becomes positive after the first week of fever), and rarely bone marrow culture. If the causative organism of enteric fever (i.e. typhoid and paratyphoid - Salmonella typhi, Salmonella paratyphi A or B... Salmonella paratyphi C is very rare) is isolated from any of the clinical specimens, then the diagnosis is confirmed. The antibiotic sensitivity of the isolate refers to the drug which will be effective in treatment, according to susceptibility (sensitivity) tests done in the laboratory to determine whether the medicines will be effective in treatment. These in-vitro (outside the body) results correlate 90% with in-vivo (inside the body) response. According to the antibiotic sensitivity results, the best medication for treatment can be selected. Usually oral quinolones (Ciprofloxacin or Ofloxacin tablets), or ceftriaxone injections are used for treatment; but nowadays there are strains of salmonella which do not respond to oral quinolones since they have higher levels of minimum inhibitory concentration (MIC) against nalidixic acid (used as a marker for clinical response to quinolones). The usual period of defervescence (the time taken for the patient to become afebrile on effective antibiotic treatment) varies from 2-10 days, with an average of around 5 days. I hope your brother recovers and gets well soon. All the best!


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