TREATMENT OF ENTERIC FEVER AND UNDIFFERENTIATED FEBRILE ILLNESS IN NEPAL: A REVIEW

Typhoid fever and paratyphoid fever (also known as enteric fever, but collectively referred here as typhoid Fevers) are severe systemic illnesses characterized by sustained fever and abdominal symptoms. Treatment of typhoid fever becomes difficult by the development of multi-drug resistant of typhoid organisms especially to ampicillin, trimethoprim-sulfamethoxazole and chloramphenicol. In recent years, gradual development of resistance to fluoroquinolones has resulted in more challenges. Cefotaxime, ceftriaxone, Ciprofloxacin, Ofloxacin, Gatifloxacin, Co-trimoxazole, Ampicillin, Chloram-phenicol, Azithromycin can be used for the treatment with the antibiotic susceptibility test. But difficulties arise with the culture negative (i.e. unidentified febrile illness). A larger study enrolling 10153 patients in Bheri Zonal Hospital and Nepalgunj Medical College in western Nepal reported that 23.45% and 31.77% cases respectively were most prevalent during June-August season. An antibiotic susceptibility was also carried out in B P Koirala Institute of Health Sciences, Dharan eastern Nepal, reported that none of the isolates were resistant to ciprofloxacin. Researchers reported that in Patan hospital no characteristics clearly distinguished typhus patients from those with blood culture-positive enteric fever. Across different region of the country there are different treatment patterns.