Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Complicated enteric fever
Shock, confusion, gastrointestinal bleeding, peritonism, severe dehydration or organ dysfunction may indicate sepsis, intestinal haemorrhage or ileal perforation.
Action: Use ABCDE, obtain blood cultures immediately without delaying treatment, start locally approved intravenous therapy with infection or microbiology input, and involve critical care and surgery early when perforation or uncontrolled bleeding is possible.
Synopsis
Recognise typhoid and paratyphoid after travel or food exposure, secure cultures before treatment when safe, manage severity and resistance intelligently, and complete exclusion, clearance and notification duties.
Enteric fever is systemic infection caused by Salmonella enterica serovars Typhi or Paratyphi, usually acquired through food or water contaminated by human faeces.
Think of sustained fever with headache, malaise and abdominal symptoms after travel to South Asia or another endemic region; diarrhoea, constipation or no bowel disturbance are all possible.
Blood culture is the first-line diagnostic test and should be obtained before antimicrobials whenever this does not delay treatment of a severely unwell patient.
Key red flags
Hypotension, altered consciousness, rising lactate, oliguria or respiratory compromise indicates severe infection and requires immediate sepsis care.
Progressive febrile illness
Fever usually rises over several days with headache, marked malaise, anorexia, dry cough or myalgia; the patient may look disproportionately unwell despite few focal signs.
Investigation priorities
01
First-line blood culturesFirst stepFirst line
Confirm bacteraemia, identify Typhi or Paratyphi and generate the susceptibility profile that controls definitive therapy.
Management branches
SAMPLE FIRSTInvestigate suspected enteric fever
Sustained fever or compatible systemic illness follows residence in or travel to an endemic setting.
Perform ABCDE, establish dates and exact locations, review antibiotics and vaccination, and assess for bleeding, peritonism, encephalopathy and shock.
Take blood-culture sets before antimicrobials if this can be done immediately; add stool culture, severity bloods and urgent malaria testing without allowing sampling to delay resuscitation.
UNCOMPLICATEDTreat stable oral disease
The patient has no shock, organ dysfunction, gastrointestinal complication or absorption problem and reliable follow-up is possible.
Key medicines
AzithromycinGive 500 mg orally once daily for seven days for uncomplicated susceptible or presumed non-extensively-drug-resistant enteric fever, unless specialist advice selects a different course.
CeftriaxoneGive 2 g intravenously once daily for complicated infection without a strong extensively-drug-resistant exposure, then step down only to a confirmed active oral agent when clinically appropriate.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.