question-icon

Suggest treatment for typhoid fever

default
Posted on Wed, 25 Jun 2014
Question: Hi XXXXXXX Sir, this is XXXXXXX XXXXXXX . XXXXX (2 yr) have blood found with S.Typhi "O". He is in home town and Dr. available there has declared as typhoid on 2nd XXXXXXX yesterday. After medicine fever 104 F came under control and remain normal till today 9:00 pm. but now temprature is going down. current temperature is 93 F. Should we worry ? any suggestion
doctor
Answered by Dr. Sumanth Amperayani (8 hours later)
Brief Answer:
Need clarifications....

Detailed Answer:
Hi,

You seem to have posted this query to Dr. XXXXXXX Kondekar. Since the query is unattended for a while, I would wish to address it. Before I give my opinion, I would like some additional details:
1.     How many days of fever is this?
2.     What are the other associated symptoms?
3.     When there is no fever or when the fever the fever comes down after giving fever medicine, how is the activity of the kid?

At the moment CBC report is not suggestive of Typhoid fever with 14300 total counts. Moreover Widal or serological test seems to have been done by Slide method and is unreliable. Even if it is done in Tube method (Reliable), the results of 1:20 and 1:40 are not suggestive of Typhoid.

Besides that, blood culture which is the gold standard test to diagnose typhoid is not done. And the kid has already been prescribed Azithromycin which is a second line drug for Typhoid.

Kindly get back to me with the answer to my above questions and I will try to do my best.

Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health.

Above answer was peer-reviewed by : Dr. Prasad
doctor
default
Follow up: Dr. Sumanth Amperayani (16 hours later)
Sir, Here are the detailed information about my son XXXXXX (2yr). Also want know can he travel from XXXXXXX to XXXXXXX by train. Someone told me that travelling is not recommended.

A week earlier than 30th May:

He was not taking food properly and was trying to avoid even water. He was touching his throat several times, although he was not coughing. He was taking tongue out and putting finger inside mouth. Was touching scrotal skin frequently. Also he was putting finger in anus.

He had rashes over neck, chest and arm that time. Toilet was not normal; he had constipation (tight motion). These both symptoms reduced as of now but are still there.

Not remembering date but consulted doctor regarding above concern and Dr. prescribed worm medicine. Even after that his behavior was not changed for few days. But as of now he is not putting finger in anus and also not taking tongue out.

When his body temperature remains normal he enjoy playing. But when caught by fever he insists or tries to go out of home. Where is resides, have only ceiling fans.

Two days before 30th May:

Was trying to avoid food and water. Also noticed mild fever but not paid attention on that and not measured.

30-MAY-2014:

Regarding fever, 1st time consulted local doctor around noon, that time fever was 100 F. Also told him all above symptoms.

Doctor has prescribed below three medicines (prescription was already attached) -
Ezithral Liquide 200
P-125
ELRIZ-XL

1st time given P-125 around 2:00 PM then around 7:00 PM

31-MAY-2014:

Measured temperature 104 F fever in night around 12:30 pm and in order to control that given 5ml Flexon as per experience.

01-MAY-2014:

Again given 5ml Flexon in morning around 7:00 AM and another does around 12:30 PM in the noon. Whenever given any fever medicine that time fever was measured around 101 – 102 F.

Taken appointment and consulted doctor regarding high fever where he prescribed few tests.

Tests: CBC, Cerogical, Urine tests and Urine Culture. Other then Urine culture I have provided all three reports to you.

Note: Dr. has not recommended blood culture, which you have highlighted as mandatory test in such cases.



02-MAY-2014:

Doctor confirmed as Typhoid by seeing reports (except urine culture) and prescribed medicine Flexon (when required), Degeplex Drops and Zocef Dry Syrup.

No high temperature noticed for the day.

03-MAY-2014:

He was dull and not interested on eating or drinking.

Around 10 PM noticed low body temperature and measured as 95 F, which went decreasing and found 93 F around 11:30 pm. Then rushed to local government hospital and there Dr. Prescribed Phenergan (Promethazine) 100ml Syrup I.P. doses 5 ml twice in a day.

No high temperature noticed for the day.

04-MAY-2014:

Consulted with doctor along with urine culture report at 11:30 AM. He has prescribed 5ml Calcimax-p twice in a day. Nothing found noticeable in urine culture as per doctor. I don’t have that report right now, thus not sharing that.

Fever remain around 94 F – 96.9 F. No high temperature noticed for the day.

Still baby tries to avoid food and water.

We are proving him khichri (rise+pulse) , chapatti with watery pulses, boiled apple , cerelac etc. Beast feeding is still on. No raw fruits are given.

## Note: All temperature measured in armpit using digital as well as mercury thermometer.
doctor
Answered by Dr. Sumanth Amperayani (12 hours later)
Brief Answer:
Could be a recovering viral illness

Detailed Answer:
Dear XXXXXXX XXXXXXX Thanks for your trust in me.

I have gone through in detail about your kids regards and understand your concerns. After all this I feel this could just be a viral illness from which your son is already recovering. The Government hospital doctor was very much right prescribing only Promethazine and Paracetamol. That is all what is needed for a viral illness. I take this opportunity to notify you some facts about viral illness. Please remember them and try to follow what I suggest.

1. Fever of few days without any localizing signs could as well a viral illness.

2. Usually rather than fever, what is more important is the activity of the child, in between 2 fever episodes on the same day. If he is active and playing around when there is no fever, it is probably viral illness and it doesn't require antibiotics at all.

3. Once viral fever comes it will there for 4-7 days. So do not worry about duration if the kid is active.

4. Paracetamol can be given in the dose of 15mg/kg/dose every 4-6th hourly that too only if fever is more than 100F. I suggest not using combination medicines for fever, especially with Paracetamol.

5. As I was suggesting above do not use Flexon as it is a combination of paracetamol and Ibuprofen, which is a NSAID. It carries the risk of gastritis and renal problems in the long run.

6. The kids will usually take some time while recovering form any fever to regain good appetite. So do not worry about the intake. If XXXXX is active and playing around, please do not force feed him.

7. Whatever you are feeding is fine, but raw fruits also can be given, but only after proper washing.

8. You can travel to XXXXXXX as his fever has touched baseline now, even otherwise he could have travelled, no problem.

Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health.
Dr. Sumanth MBBS., DCH., DNB (Paed).,

Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
Dr.
Dr. Sumanth Amperayani

Pediatrician, Pulmonology

Practicing since :2003

Answered : 8285 Questions

premium_optimized

The User accepted the expert's answer

Share on
Suggest treatment for typhoid fever

Brief Answer: Need clarifications.... Detailed Answer: Hi, You seem to have posted this query to Dr. XXXXXXX Kondekar. Since the query is unattended for a while, I would wish to address it. Before I give my opinion, I would like some additional details: 1. How many days of fever is this? 2. What are the other associated symptoms? 3. When there is no fever or when the fever the fever comes down after giving fever medicine, how is the activity of the kid? At the moment CBC report is not suggestive of Typhoid fever with 14300 total counts. Moreover Widal or serological test seems to have been done by Slide method and is unreliable. Even if it is done in Tube method (Reliable), the results of 1:20 and 1:40 are not suggestive of Typhoid. Besides that, blood culture which is the gold standard test to diagnose typhoid is not done. And the kid has already been prescribed Azithromycin which is a second line drug for Typhoid. Kindly get back to me with the answer to my above questions and I will try to do my best. Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health.