Treatment of typhoid in adults

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

Scheme of treatment of typhoid fever

The main directions of therapeutic measures	Preparations, schemes of application
Dietotherapy	The entire febrile period is table 4A, then 4, 2 and 13
Antibiotic therapy	In connection with the wide spread of strains of S. Typhi, resistant to chloramphenicol. Ampicillin, co-trimoxazole. The drugs of choice were fluoroquinolones: ciprofloxacin 0.5-0.75 g twice daily after meals: ofloxacin 0.2-0.4 g twice daily in or in: pefloxacin 0.4 g twice daily inside or in / in. Highly effective ceftriaxone (an alternative drug) is 1.0-2.0 g IV once a day. Antibiotic therapy is carried out until the 10th day after the normalization of body temperature
Immunotherapy - according to the indications (prolonged bacterial release, exacerbations, retsedivy)	Pentoxyl, metacil, thymogen, typhoid vaccine
Disintoxication therapy - according to indications (typhoid status arterial hypotension, hyperthermia and other manifestations of intoxication)	Intravenously Ringer's solution, 5% glucose solution, reopolyglucin, reamberin, etc.
Vitaminotherapy, antioxidant therapy according to individual indications	Ascorbic acid - for 20-30 days to 0.05 g three times a day: cytochrome C - iv 5 ml. Vitamin E at 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, the average length of hospitalization for patients with typhoid fever is 25 days, the average length of hospitalization is 30 days, and the average length of hospitalization is 45 days.

Treatment of typhoid, in accordance with federal standards, is carried out in the following areas: antibacterial, detoxification and plasma-substituting solutions, desensitizing agents, vitamin therapy, antispasmodics, biologics, symptomatic drugs, amino acids, sugars and preparations for parenteral nutrition, hormones and their analogues (according to indications ).

Until the sixth-seventh day of normal temperature, the patient must comply with bed rest, from the seventh to the eighth day they are allowed to sit, and from the tenth to the eleventh day of normal temperature, in the absence of contraindications, they are allowed to walk.

The discharge of patients who have recovered from the hospital is made after a clinical recovery, but not earlier than 21-23 days after the temperature normalization and after receiving a double negative bacteriological study of feces and urine and a single - duodenal contents.

Prognosis for typhoid fever

In the preantibiotic period, the lethality in typhoid fever was 3-20%, while the timely treatment of typhoid fever was 0.1-0.3%.

Clinical examination

Having recovered with typhoid fever irrespective of profession and employment after discharge from the hospital, they are subject to follow-up at the polyclinic of the clinic for 3 months. For the timely detection of relapse after convalescents, medical observation with thermometry is established once a week for the first 2 months and once every 2 weeks during the 3rd month.

In all cases of typhoid fever (except for workers of food enterprises and persons equated to them), a single bacteriological examination of feces and urine is performed monthly during a 3-month follow-up observation, and by the end of the third month additionally - bile sowing and Vi-hemagglutination reaction. Further, these persons are on the account of sanitary and epidemiological supervision for two years. During this period, they twice a year produce bacteriological examination of feces and urine, and at the end of the observation period - bile sowing. At negative results of bacteriological researches recovered take off from the account.

Convalescents of typhoid fever from the number of employees of food enterprises and persons equated to them are not allowed to work in the specialty within a month after discharge from the hospital. At 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 sowing and Vi-hemagglutination reaction. Persons with a positive reaction of Vi-hemagglutination are not allowed to work. At them spend additional bacteriological research of vydeleny not less than five times and bile - once. Only with negative results of bacteriological examination and well-being such convalescents are allowed to work in the specialty.

When negative results are obtained, convalescent patients are allowed to work in food and equivalent institutions with mandatory monthly bacteriological examination of feces and urine during the year and by the end of the third month - with bile sowing and the establishment of the Vi-hemagglutination reaction. Later these persons are registered in the KIZ for 5 years with a quarterly bacteriological study of feces and urine, and then during the whole of their work they twice each year perform a bacteriological study of feces and urine.

Chronic bacterial carriers of typhoid microbes stay for life on the account of sanitary and epidemiological supervision bodies and in KIZ and twice a year are subjected to bacteriological research and clinical examination. On the same account, there are and are subject to a similar survey of convalescents of typhoid fever, in which typhoid germs of bile were isolated during hospitalization. Chronic bacterial carriers, as well as those living with them, are suspended from work at food industry, public catering and trade enterprises, in medical, sanatorium-and-spa institutions, pharmacies, etc.

[1], [2], [3], [4], [5], [6], [7], [8],

Memo for patients

It is recommended the rational employment of reconvalescent for 2-3 months with the release of heavy physical labor, sports, travel. Treatment of typhoid fever should be combined with dietary nutrition for a period of 2-3 months with the exclusion of spicy foods, alcohol, animal fats, adherence to diet and personal hygiene.