Publication: Management of Typhoid fever in the Department of Medicine at Kathmandu Medical College
Date
2003
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Aim
1. To assess the ongoing management
strategy of typhoid fever in department
of medicine at Kathmandu Medical
College, Sinamangal, Kathmandu.
1. To suggest changes, if required for the
benefit of patients and doctors
Method
Prospective study of clinically suspected enteric
fever from 2060/01/29 to 2060/04/25. Assessment
and analysis of the rationality of the diagnostic
parameters that are being used in the ward for
clinically suspected enteric fever in unit one of
department of medicine. Treatment outcome of
the patients with the commonly used antibiotics.
Analysis of the sensitivity pattern of the
salmonellae isolated among the study group.
Result
1. Only 11 cases (37%) were actually
culture proven among the 30 cases
suspected to be enteric fever on clinical
basis.
2. 19 cases (63 %) of the clinically
suspected enteric fever were diagnosed
only on the basis of single widal test
(titre more than 1:320), blood culture
being negative.
3. Bone marrow was subjected to culture
for salmonella only in 4 Cases (13%)
despite blood culture being sterile.
4. The laboratory could provide sensitivity
pattern of salmonellae only in 5 cases
out of 11 culture positive cases (45%).
5. Eighteen cases (60%) had to be given 3rd
generation cephalosporin after not
responding to 5 days course of
fluoroquinolones (ciprofloxacin or
ofloxacin). On the other hand all the
cases in the study group subjected to 3rd
generation cephalosporin (injection
ceftriaxone or cefixime orally)
responded well to the treatment.
Conclusion
1. We shouldn’t be relying too heavily on a
single titre of widal test for the diagnosis
of enteric fever and should be sending
blood for culture for salmonella and even
bone marrow culture, if necessary. This
can be concluded on the basis of lots of
literature against single widal test in the
diagnosis of enteric fever.
2. Widal test should be positive with
clearly significant rising titre (with
paired sample) or modified widal test has
to be performed if one wants to give
gravity to the test for the diagnosis of
enteric fever.
3. Laboratory personnel’s need to be more
serious in their works so as to try to see
sensitivity pattern in all positive cultures,
if rational use of antibiotics is really
desired in view of increasing antibiotic
resistance.
4. Fluoroquinolones, once thought to be
super powerful antibiotic & still taken as
the drug of choice almost everywhere,
has been found to be resistant in most of
the cases in this study. Though the
sample size is too small and there are
lots of limitations in this study to come
to a firm conclusion, it has borne one
serious question in the minds of our unit
doctors:
Correspondence
Dr. Mahesh Dhakal
Dept. of Medicine,
Kathmandu Medical College, Teaching Hospital
Kathmandu University Medical Journal (2003) Vol. 1, No. 3, 197-204
198
whether we are over-using fluoroquinolones
for trivial infections and leading to the
emergence of resistant strains of
salmonellae?