علاج الحمى المعوية الشديدة أو المعقدة عند عدم القدرة على تحمل العلاج الفموي

References

• Severe enteric fever, patients unable to tolerate oral treatment due to vomiting and/or severe diarrhoea, and/or patients with intestinal/extra-intestinal complications typically require hospitalisation and parenteral antimicrobial treatment.
• Not susceptible to ciprofloxacin, but susceptible to ceftriaxone.
• Intravenous ceftriaxone/cefotaxime or ciprofloxacin (intravenous or oral) is recommended as empiric treatment for severe and complicated enteric fever in South Africa.
• Once patients have clinically improved, treatment can be completed with appropriate oral antibiotics (e.g. oral ciprofloxacin or azithromycin, depending on the antimicrobial susceptibility profile).
• Data are limited, but concurrent treatment with high-dose dexamethasone should be considered for patients with severe enteric fever with delirium, obtundation, coma or shock.
• In patients with severe enteric fever with intestinal perforation and peritonitis, surgical intervention is recommended.
• Intestinal bleeding, perforations or ulcerations are life-threatening and may require immediate fluid resuscitation, surgical interventions and broad-spectrum antimicrobial coverage for polymicrobial peritonitis.