Typhoid | Medical Science Optional Notes for UPSC PDF Download

Typhoid management

• Swift administration of appropriate antibiotic therapy is crucial in preventing severe complications of enteric fever.
• The initial selection of antibiotics relies on the susceptibility of S.Typhi in the resident or travel area.
• Empirical treatment of enteric fever in the Indian subcontinent, Nepal, and Africa should no longer include fluoroquinolones.
• Strains with decreased ciprofloxacin susceptibility (DCS) should be treated with ceftriaxone or azithromycin, while ciprofloxacin-resistant enteric fever requires ceftriaxone, cefotaxime, or oral cefixime.
• For severe infections, third-generation cephalosporins, such as ceftriaxone (2 g/d IV for 10-14 days), are the preferred choice.
• Chronic carriers should undergo a 4-week therapy with ciprofloxacin, as amoxicillin and TMP-SMX are no longer recommended.

Typhoid prevention

• Adequate disposal of sewage and water treatment are essential measures.
• There are two commercially available typhoid vaccines:
  a. Ty21a, an oral live attenuated S. Typhi vaccine administered on days 1, 3, 5, and 7, with revaccination every 5 years.
  b. Vi CPS, a parenteral vaccine containing purified Vi polysaccharide from the bacterial capsule, given as a single dose with a booster every 2 years.
• The minimum age for Ty21a vaccination is 6 years, while for Vi CPS, it is 2 years.

Travel immunization

• While not mandatory for international travel, a typhoid vaccine is advised for individuals visiting regions with a moderate to high risk of S. Typhi exposure.
• Particularly, travelers to southern Asia, as well as other developing areas in Asia, Africa, the Caribbean, and Central and South America, are encouraged to get vaccinated, especially if they anticipate exposure to potentially contaminated food and beverages.
• It is recommended to consider the typhoid vaccine even for individuals with plans for less than two weeks of travel to high-risk regions.
• Furthermore, vaccination is suggested for laboratory personnel handling S. Typhi and for household members in contact with known carriers of S. Typhi.