Typhoid CPG

Question 1

yous suspect typhoid fever if patient presents with how many days of fever?

Answer 1

more than or equal to 5

Question 2

fever should be documented to be how many degrees celcius?

Answer 2

more than 38

Question 3

the following are symptoms associated with typhoid fever except?
headache
diarrhea
body malaise
abdominal pain/distention
GI bleeding
change in sensorium
epistaxis

Answer 3

epistaxis

the rest mentioned above are associated with typhoid

Question 4

typhoid fever that warrants hospital admission?

Answer 4

1. complicated typhoid
2. typhoid in pregnancy
3. social circumstances not favoring home care

Question 5

the following are direct detection method to confirm the diagnosis of typhoid fever

a. culture and isolation
b. PCR
c. tubex test

Answer 5

C.

PCR and culture and isolation are direct methods

Question 6

true or false widal test is still recommended for the diagnosis of typhoid espcecially in our country?

Answer 6

False. local CPG does not recommend using widal test for diagnosis of fever

Question 7

the following are recommended medications for treatment of uncomplicated typhoid fever

a. amoxicillin
b. amoxicillin+clavulanic acid
c. ceftriaxone
d. levofloxacin

Answer 7

A. amoxicillin
for uncomplicated typhoid fever the following antibiotics are recommended
a. amoxicillin, chloramphenicol, cotri, cefixime, azithromycin, ciprofloxacin, ofloxacin

Question 8

recommended dose for amoxicillin for uncomplicated typhoid fever?

Answer 8

500 mg 2 caps q 6 x 14 days

Question 9

recommended dose for chloramphenicol for uncomplicated typhoid

Answer 9

500 mg 2 caps q 6 x 14 days

Question 10

recommended dose for cotri for uncomplicated typhoid

Answer 10

800/160 1 tab q12 x 14 days

Question 11

recommended dose for azithromycin for uncomplicated typhoid

Answer 11

500 mg 1-2 tabs q24h x 7 days

Question 12

recommended dose for cefixime for uncomplicated typhoid

Answer 12

200 mg q 12 x 7 days

Question 13

recommended dose for ciprofloxacin for uncomplicated typhoid

Answer 13

500 mg q12 x 7 days

Question 14

recommended dose for ofloxacin for uncomplicated typhoid

Answer 14

400 mg 1 tab a 12 x 7 days

Question 15

mnemonic for drugs used to treat uncomplicated typhoid for 14 days C-A-T

Answer 15

chloramphenicol-amoxicillin- tmp-smx

the rest are given x 7 days

Question 16

patient was treated for uncomplicated typhoid fever and developped SJS what drug most likely caused this?

Answer 16

TMP-SMX

Question 17

patient treated for uncomplicated typhoid came to you with cbc results showing signs of bone marrow suppression. you suspect what drug?

Answer 17

chloramphenicol

Question 18

these drugs used to treat uncomplicated typhoid are associated with prolonged QT interval?

Answer 18

Azith, cipro, oflox (A-C-O)

Question 19

the treatment duration for azithromycin when used to treat complicated typhoid fever is how many days?

Answer 19

7 days

Question 20

recommened dose for ceftriaxone for treatment of complicated typhoid fever?

Answer 20

2 - 3 grams iv q 24 x 14 days

Question 21

recommened dose for azihromycin for treatment of complicated typhoid fever?

Answer 21

1 gram q 24 x 7 days

Question 22

recommened dose for ciprofloxacin for treatment of complicated typhoid fever?

Answer 22

400 mg q12 x 14 days

Question 23

recommened dose for ofloxacin for treatment of complicated typhoid fever?

Answer 23

400 mg q12 x 14 days

Question 24

when should iv antibiotics be stepped down to oral antibiotics?

Answer 24

48 hours afebrile, able to tolerate PO medication

Question 25

first line treatment for pregnant patients with typhoid fever?

Answer 25

ampicillin 1-2 grams iv q 6 x 10-14 days ceftriaxone 2-3 grams iv q24 x 7 days

Question 26

multidrug resistant typhoid fever is resistant to the following medications except? a. cotrimoxazole b. amoxicillin c. ampicillin d. TMP-SMX

Answer 26

b. Amoxicillinn | MDR resistant to Chloram-Ampicillin-TMP-SMX

Question 27

when to suspect if patinet has MDRTF

Answer 27

1. failure to respond after 5-7 days 2. household contact with MDR strain 3. documented epidemic of MDR strain

Question 28

emperic treatment for MDR strain

Answer 28

cefixime 200 mg q12 ciprofloxacin 500 mg 12 ofloxacin 400 mg q12 azithromycin 500 1-2 tabs q 24 all treatment given fro 7 days PO

Question 29

how do you define a chronic carrier?

Answer 29

positive stool or rectal swab a year after recovery

Question 30

treatment for chronic carriers?

Answer 30

``` TMP - SMX 800/160 1 tab q 12 x 6-12 weeks Amox 100 mg/kg/day x 6-12 weeks ampicillin 100 mg/kg/day x 6-12 weeks norfloxacin 400 1 tab q12 x 4 weeks ciprofloxacin 750 1 tab q12 x 4 weeks ```

Question 31

typhoid vaccines indicated for?

Answer 31

1. travel to endemic area 2. person with intimate contact to carrier 3. lab workers routinely exposed

Question 32

endemic areas?

Answer 32

sub-saharan africa, cetral asia, indian subcontinent, latin america, middle east, south and southeast asia

Question 33

vi polysaccharide vaccine

Answer 33

1 dose booster 1 dose every 2 years

Question 34

live attenuated ty21a vaccine

Answer 34

1 capsule 4 doses, booster every 5 years | days 0,2,4,6