Enteric Fever

The current drug of choice for typhoid fever is a fluoroquinolone, such as ciprofloxa-cin. The recommended adult dose of ciprofloxacin for uncomplicated typhoid is 500 mg orally twice daily for 5 to 7 days. Drug resistance is a recognized problem in the Indian subcontinent, Southeast Asia, Mexico, the Arabian Gulf, and Africa. All S. typhi isolates should be screened for nalidixic acid and fluoroquinolone resistance. If nalidixic acid resistance is present, the patient should be given higher doses of cipro-floxacin or ofloxacin (10 mg/kg twice daily) for 10 to 14 days. A third-generation cephalosporin and azithromycin (1,000 mg once on day 1 followed by 5 days of 500 mg daily) are alternative agents for S. typhi strains, with minimum inhibitory concentration (MIC) values for ciprofloxacin of 2 mcg/mL or greater.8 Children may receive intravenous ceftriaxone 75 mg/kg daily or oral azithromycin 20 mg/kg (up to 1 g) daily, although relapse rates are higher with ceftriaxone.

Table 76-3 Antimicrobial Indications for Nontyphoidal Salmonellosis

Age 3 months or less; 65 years or more Fever and systemic toxicity

AIDS and other immunodeficiencies (including steroid use or organ transplantation)

Uremia or hemodialysis or renal transplant Malignancy

Sickle cell anemia or hemoglobinopathy Inflammatory bowel disease

Aortic aneurysm, prosthetic heart valve, vascular or orthopedic prosthesis

Curing Irritable Bowel Syndrome

Curing Irritable Bowel Syndrome

Everyone has an upset stomach from time to time. You probably know the sort of thing I mean – sometimes you’ve got gas and at other times you feel queasy or nauseous. There may be times<br />when you can’t seem to go to the toilet for days, constipated as can be, but there are other days when diarrhea strikes and you can’t stop going!

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