Typhoid Fever (Enteric Fever)
Description General Measures Medicine Treatment Referral ICD-10 code: A01.0-4 *Notifiable medical condition (Typhoid fever). DESCRIPTION Systemic infection due to S. enteritica serotype Typhi or related organisms (e.g. S. paratyphi , S. choleraesuis ). Initial symptoms are abdominal pain, headache, cough and fever, with diarrhoea developing after a few days. Bacteraemia is common in the first wee
ICD-10 code: A01.0-4
*Notifiable medical condition (Typhoid fever).
DESCRIPTION
Systemic infection due to S. enteritica serotype Typhi or related organisms (e.g. S. paratyphi, S. choleraesuis). Initial symptoms are abdominal pain, headache, cough and fever, with diarrhoea developing after a few days. Bacteraemia is common in the first week of illness, subsequently stool culture has the highest yield.
GENERAL MEASURES
- Transfusion is indicated for severe haemorrhage.
- Replace fluid and electrolytes.
- Contact isolation during acute phase of illness.
MEDICINE TREATMENT
Antibiotic therapy
Note:
There is increasing resistance to ciprofloxacin in South Africa. Ensure that specimens are sent for culture and sensitivity prior to commencing antibiotic therapy.
Total duration of antibiotic therapy: 10 days.
- Ceftriaxone, IV, 2 g 12 hourly.
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Follow with oral therapy as soon as patient can swallow and the temperature is <37.8°C for 24 hours, based on culture sensitivity results:
- Ciprofloxacin, oral, 500 mg 12 hourly.
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Note:
- Stool cultures must be repeated at weekly intervals after clinical recovery to ensure that a carrier state has not developed.
- Two consecutive negative stool cultures are required to exclude carrier state. This is of vital importance in patients whose occupation includes handling of food, whereby negative stool culture results are required before they can be medically permitted to resume their occupational duties.
Chronic carriers:
ICD-10 code: (Z22.0)
- Ciprofloxacin, oral, 500 mg 12 hourly for 6 weeks (if sensitive to ciprofloxacin).
- Advise strict hand washing.
- Avoid food preparation for others during severe illness.
REFERRAL
- Surgical consultation for complications such as intestinal haemorrhage, threatening bowel perforation or localisation with metastatic infection with or without abscess formation, and peritonitis.
- Drug resistant organism: consult microbiology/infectious diseases services.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.2_20 January 2025
Chapter 9 Systemic and Healthcare-Associated Infections_9.11 Typhoid Fever (Enteric Fever)