Management

Question 1

Empiric treatment of Enteric fever?

Answer 1

1- Mild symptoms : oral azithromycin (7 days)
2- Complicated infection : IV ceftriaxone then IVOST to azithro or cipro (if sensitive) for 7 days
3- Empirical cipro should not be used

If return from area of XDR EF:
1- Uncomplicated case - oral azithromycin
2- Complicated case - oral azithromycin with IV meropenem

Once sensitivity is known :

1- If azithromycin sensitive - seven days oral azithromycin
2- If Azithromycin resistant - meropenem or another agent to which the isolate is susceptible for 10 days and discussion with the reference laboratory

Question 2

Treatment of a confirmed salmonella chronic carrier?

Answer 2

Oral ciprofloxacin (750 mg PO BD x 28 d)
Or : azithromycin (500 mg OD x 28d)
Or amoxicillin (1 g PO TDS x 28d)

Question 3

T/F :

No need for test for clearance after treating a salmonella chronic carrier ?

Answer 3

• Monthly stool samples should be taken following treatment to confirm clearance, starting one month after treatment completion.
• A negative stool sample should be followed by two further samples taken at least 48 h apart to confirm successful clearance.

Question 4

Tx of Non-typhoidal salmonella infections???

Answer 4

Drug of choice - Ciprofloxacin (PO pref), ceftriaxone (IV pref)

Also can use:
~ cotrimoxazole, azithromycin (see EUCAST guideline), amoxicillin.

Duration - 3 - 7 days. Severe cases/immunocompromised patients 14 days or, in some cases, longer.

Question 5

Is Tx for non-typhoidal salmonella carrier is indicated?

Answer 5

Not routinely
only if indicated by HPT in certain situation..
OPTIONS:
cipro for 4 weeks/amox 6 weeks/cotrim 12 weeks.

follow up:
1 week after completing treatment, test for Salmonella daily for 7 days.