Este protocolo aborda pacientes com febre entérica grave ou complicada causada por um organismo extensivamente resistente a medicamentos (XDR) — resistente a múltiplas classes de antibióticos padrão — que não podem ser tratados apenas com terapia oral e requerem tratamento parenteral hospitalar urgente.
Pacientes que se apresentam com doença grave, incapacidade de tolerar tratamento oral devido a vômitos e/ou diarreia grave, ou complicações intestinais e extra-intestinais da febre entérica geralmente requerem hospitalização e terapia antimicrobiana parenteral.
O organismo infectante é extensivamente resistente a medicamentos: resistente a cloranfenicol, amoxicilina, cotrimoxazol, ciprofloxacino e ceftriaxona. Esse perfil de resistência limita substancialmente as opções de tratamento disponíveis.
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.
Extensively drug resistant: resistant to chloramphenicol, amoxicillin, cotrimoxazole, ciprofloxacin and ceftriaxone.
Treatment options for extensively drug-resistant enteric fever are limited to azithromycin (for uncomplicated disease) and meropenem (for severe disease).
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.
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