Treatment of typhoid fever in adults

Modern treatment of typhoid fever is based on the complex use of etiotropic and pathogenetic therapy.

Treatment regimen for typhoid fever

Main directions of therapeutic measures	Preparations, application schemes
Diet therapy	The entire febrile period - table 4A, then 4, 2 and 13
Antibacterial therapy	Due to the widespread distribution of S. typhi strains resistant to chloramphenicol, ampicillin, co-trimoxazole, fluoroquinolones have become the drugs of choice: ciprofloxacin 0.5-0.75 g twice a day after meals: ofloxacin 0.2-0.4 g twice a day orally or intravenously: pefloxacin 0.4 g twice a day orally or intravenously. Ceftriaxone (an alternative drug) is highly effective at 1.0-2.0 g intravenously once a day. Antibiotic therapy is carried out until the 10th day after normalization of body temperature.
Immunotherapy - according to indications (long-term bacterial excretion, exacerbations, relapses)	Pentoxil, metacil, thymogen, typhoid vaccine
Detoxification therapy - as indicated (typhoid status, arterial hypotension, hyperthermia and other manifestations of intoxication)	Intravenous Ringer's solution, 5% glucose solution, rheopolyglucin, reamberin, etc.
Vitamin therapy, antioxidant therapy according to individual indications	Ascorbic acid - for 20-30 days, 0.05 g three times a day; cytochrome C - intravenously, 5 ml; vitamin E, 0.05-0.1 g/day; aevit - 1 capsule (0.2 ml) three times a day; unitiol - 0.25-0.5 g daily or every other day.

According to federal standards for the volume of medical care provided to patients with typhoid fever, the average duration of hospitalization for patients with a mild form is 25 days, moderate - 30 days, severe - 45 days.

Treatment of typhoid fever, in accordance with federal standards, is carried out in the following areas: antibacterial, detoxifying and plasma-substituting solutions, desensitizing agents, vitamin therapy, antispasmodics, biopreparations, symptomatic agents, amino acids, sugars and preparations for parenteral nutrition, hormones and their analogues (as indicated).

Until the sixth or seventh day of normal temperature, the patient must remain in bed; from the seventh or eighth day, he or she is allowed to sit, and from the tenth or eleventh day of normal temperature, in the absence of contraindications, he or she is allowed to walk.

Patients who have recovered from the disease are discharged from the hospital after clinical recovery, but not earlier than the 21st-23rd day from the moment the temperature returns to normal and after receiving a double negative bacteriological test of feces and urine and a single negative test of duodenal contents.

Prognosis for typhoid fever

In the pre-antibiotic period, the mortality rate for typhoid fever was 3-20%; if typhoid fever is treated in a timely manner, it is 0.1-0.3%.

Clinical examination

Those who have recovered from typhoid fever, regardless of their profession and employment, are subject to dispensary observation in the KIZ of the polyclinic for 3 months after discharge from the hospital. For the timely detection of relapse, convalescents are placed under medical observation with thermometry once a week during the first 2 months and once every 2 weeks during the 3rd month.

All those who have recovered from typhoid fever (except for food industry workers and persons equivalent to them) undergo a single bacteriological examination of feces and urine every month during a 3-month dispensary observation, and by the end of the third month, additionally, bile culture and the Vi-hemagglutination reaction. Then, these persons are registered with the sanitary and epidemiological supervision authorities for two years. During this period, they undergo bacteriological examination of feces and urine twice a year, and at the end of the observation period, bile culture. If the results of bacteriological examinations are negative, those who have recovered are removed from the register.

Typhoid fever convalescents from among food industry workers and persons equivalent to them are not allowed to work in their specialty for a month after discharge from the hospital. During this time, in addition to medical observation, it is necessary to conduct fivefold bacteriological examination of feces and urine with an interval of 1-2 days, a single bile culture and a Vi-hemagglutination reaction. Persons with a positive Vi-hemagglutination reaction are not allowed to work. They undergo additional bacteriological examination of secretions at least five times and bile - once. Only with negative results of bacteriological examination and good health are such convalescents allowed to work in their specialty.

If the results are negative, convalescents are allowed to work in food and equivalent institutions with mandatory monthly bacteriological examination of feces and urine for a year and by the end of the third month - with bile culture and Vi-hemagglutination reaction. Subsequently, these persons are registered in the KIZ for 5 years with quarterly bacteriological examination of feces and urine, and then throughout their entire working life, they undergo bacteriological examination of feces and urine twice a year.

Chronic carriers of typhoid microbes are registered with the sanitary and epidemiological surveillance authorities and in the KIZ for life and are subject to bacteriological testing and clinical examination twice a year. Convalescents of typhoid fever, from whom typhoid microbes were isolated from bile during their stay in the hospital, are also registered and subject to similar testing. Chronic carriers of the bacteria, as well as persons living with them, are suspended from work in food industry enterprises, public catering and trade, in medical, health resort institutions, pharmacies, etc.

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Patient information sheet

It is recommended to rationally employ convalescents for 2-3 months with exemption from heavy physical labor, sports, business trips. Treatment of typhoid fever should be combined with dietary nutrition for a period of 2-3 months with the exclusion of spicy food, alcohol, animal fats, adherence to the diet and rules of personal hygiene.