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Suggest Treatment For Paratyphoid Fever
Question: My wife age 38 is detected S. Paratyphi AH positive. What medicine should she take. Since I am currently at Yangon (Myanmar). It would be great help if you suggest medicines.
Brief Answer:
I'm suggesting two regimens
Detailed Answer:
Hello,
normally ciprofloxacin 400mg (intravenous administration) twice daily or levofloxacin 750mg (by mouth) for 7-10 days should be enough.
Dexamethasone may be added to the regimen to severely ill patients.
Since she's in Asia (and very close to India) where paratyphi resistance is high I'll suggest an alternative regimen. You should consult a local doctor regarding local resistance rates. Azithromycin 1gr once for the first day and 500mg (once per day) for 5-7 days can be more efficient. Ceftriaxone can substitute azithromycin but it has to be given intravenously.
The aforementioned doses refer to bacteremia by Salmonella. If it is only a gastroenteritis then the doses can be lower (and all by mouth).
I hope I've helped!
Contact me again, if you need any clarification on the above.
Best wishes for a speedy recovery!
I'm suggesting two regimens
Detailed Answer:
Hello,
normally ciprofloxacin 400mg (intravenous administration) twice daily or levofloxacin 750mg (by mouth) for 7-10 days should be enough.
Dexamethasone may be added to the regimen to severely ill patients.
Since she's in Asia (and very close to India) where paratyphi resistance is high I'll suggest an alternative regimen. You should consult a local doctor regarding local resistance rates. Azithromycin 1gr once for the first day and 500mg (once per day) for 5-7 days can be more efficient. Ceftriaxone can substitute azithromycin but it has to be given intravenously.
The aforementioned doses refer to bacteremia by Salmonella. If it is only a gastroenteritis then the doses can be lower (and all by mouth).
I hope I've helped!
Contact me again, if you need any clarification on the above.
Best wishes for a speedy recovery!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
She is suffering from very high fever (103) for last 5 days in spikes (103 is not constant through out the day it varies between 100 to 103) . Fever comes 3 times in a day and then with Paracetamol (650 mg) it subsided. But she had severe headache throughout the day. Eventhough when Fever subsided, Headache never relieved. Also when fever came, she severely feel chill and sever.
Local doctor thought it was Viral fever, but when it didn't go even after 4 days , she referred for Blood investigations (Widal test and malaria MP Film test). Malaria came negative.
In widal test S.paratyphy AH came positive where as S.paratyphy AO came negative. So what is the meaning of the same and what treatment (medication) you are suggesting.
Local doctor thought it was Viral fever, but when it didn't go even after 4 days , she referred for Blood investigations (Widal test and malaria MP Film test). Malaria came negative.
In widal test S.paratyphy AH came positive where as S.paratyphy AO came negative. So what is the meaning of the same and what treatment (medication) you are suggesting.
Brief Answer:
azithromycin should be ok
Detailed Answer:
Hi,
thanks for the details. Of course clinical examination cannot be substituted, so you should seriously take into account the local doctor's opinion. The high dose azithromycin should be OK. 1gr on the first day and 500mg for the next week. It's easier than the other treatements and should be efficient. You should however contact the local doctor and ask about local bacterial sensitivities.
Please note that the Widal test is rarely used because it's not practical and accurate. The O component usually signifies acute infection. Having only one test is not conclusive about typhi or paratyphi. You need a second sample 7 days after the first. The titles should be rising, but taking antibiotics may not allow them to do so.
Since we're interested in the patient's well-being, I suggest giving her the treatment and check again (the O and H) next week. If she gets OK with the treatment (or without it!) nobody would really care what happened.
If she develops signs of severe sepsis like hypotension, very fast heart rate etc then she should visit the emergency room at once.
Kind Regards!
azithromycin should be ok
Detailed Answer:
Hi,
thanks for the details. Of course clinical examination cannot be substituted, so you should seriously take into account the local doctor's opinion. The high dose azithromycin should be OK. 1gr on the first day and 500mg for the next week. It's easier than the other treatements and should be efficient. You should however contact the local doctor and ask about local bacterial sensitivities.
Please note that the Widal test is rarely used because it's not practical and accurate. The O component usually signifies acute infection. Having only one test is not conclusive about typhi or paratyphi. You need a second sample 7 days after the first. The titles should be rising, but taking antibiotics may not allow them to do so.
Since we're interested in the patient's well-being, I suggest giving her the treatment and check again (the O and H) next week. If she gets OK with the treatment (or without it!) nobody would really care what happened.
If she develops signs of severe sepsis like hypotension, very fast heart rate etc then she should visit the emergency room at once.
Kind Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
If widal test is not refered generally due to doubt on its accuracy then what test do you suggest to get further confirmation ?
Also since there is very high Fever, should i give paracetomol alongwith Azithromycine ?
What diet restrictions / suggestion you are advising ? Can she take all kind of fruits like Guava, Apple, papaya ?
also why her Headache is not subsiding evenwhen there is low fever ?
Also since there is very high Fever, should i give paracetomol alongwith Azithromycine ?
What diet restrictions / suggestion you are advising ? Can she take all kind of fruits like Guava, Apple, papaya ?
also why her Headache is not subsiding evenwhen there is low fever ?
Brief Answer:
Blood cultures are more feasible
Detailed Answer:
Hi,
the most efficient method is bone marrow aspiration, which is a painful procedure. Three blood cultures may have a sensitivity for detection as high as 97% in the first week (particularly before antibiotics). The bone marrow aspirate can be positive even a few days after starting proper antibiotic treatment.
If she's not having any gastrointestinal symptoms then she should drink enough fluids and eat whatever she likes. If she does then it would be better if she was restricted of fatty food. Fruits should be meticulously washed and pealed.
Headache comes with typhoid fever and is usually strong.
Please note that the aforementioned advice was given with the diagnosis of typhoid fever in regard. Any patient with high fever and headache has to be clinically examined to exclude the possibility of meningitis!
Since she's a healthy young woman, paracetamol can be safely given, no matter what the cause is.
Kind Regards!
Blood cultures are more feasible
Detailed Answer:
Hi,
the most efficient method is bone marrow aspiration, which is a painful procedure. Three blood cultures may have a sensitivity for detection as high as 97% in the first week (particularly before antibiotics). The bone marrow aspirate can be positive even a few days after starting proper antibiotic treatment.
If she's not having any gastrointestinal symptoms then she should drink enough fluids and eat whatever she likes. If she does then it would be better if she was restricted of fatty food. Fruits should be meticulously washed and pealed.
Headache comes with typhoid fever and is usually strong.
Please note that the aforementioned advice was given with the diagnosis of typhoid fever in regard. Any patient with high fever and headache has to be clinically examined to exclude the possibility of meningitis!
Since she's a healthy young woman, paracetamol can be safely given, no matter what the cause is.
Kind Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Does Azithromycine should be taken before food or after food ?
Also If I understood correctly 1st day 1 G one tme and then 500 mg one time daily . is it correct ?
Also If I understood correctly 1st day 1 G one tme and then 500 mg one time daily . is it correct ?
Brief Answer:
Most azithromycin preparations can be taken at any time
Detailed Answer:
Hi,
there is an extended release azithromycin preparation that has to be taken when the stomach is empty (1 hour before the meal or 2 hours after the meal).
Most preparation can be given regardless of food intake. Please advise her to avoid using antacids at the same time.
Regarding your second question the answer is yes.
1000mg on the first day, 500mg on the second day and so on.
Most azithromycin preparations can be taken at any time
Detailed Answer:
Hi,
there is an extended release azithromycin preparation that has to be taken when the stomach is empty (1 hour before the meal or 2 hours after the meal).
Most preparation can be given regardless of food intake. Please advise her to avoid using antacids at the same time.
Regarding your second question the answer is yes.
1000mg on the first day, 500mg on the second day and so on.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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