Synopsis
Recognise enteric fever after travel, obtain cultures before antimicrobial exposure, treat according to severity and resistance and coordinate notification, exclusion and clearance with UK health protection.
- Suspect enteric fever in a returning traveller with sustained fever, headache, malaise and abdominal symptoms, even when diarrhoea is absent.
- Ask exact countries, dates, urban or rural exposure, food and water, visiting friends and relatives, vaccination and every antibiotic taken abroad.
- Obtain multiple blood-culture sets before antibiotics; blood culture is the practical first-line diagnostic test early in illness.
Key red flags
Peritonism, sudden worsening abdominal pain or free air suggests ileal perforation requiring emergency surgery.
Delirium, encephalopathy, meningism or reduced consciousness indicates complicated illness and mandates urgent hospital treatment.
Investigation priorities
Recover S Typhi or Paratyphi and determine susceptibility before antimicrobial exposure.
Management branches
A traveller has sustained fever and an exposure pattern compatible with typhoid or paratyphoid.
- Use immediate travel and malaria assessment, examine for shock, encephalopathy, bleeding and peritonism and begin enteric isolation precautions.
- Obtain several blood-culture sets, stool culture, full blood count, renal and liver profile before antibiotics when this causes no dangerous delay.
The patient is stable, can absorb tablets, has no complication and resistance risk is addressed.
Key medicines
Ceftriaxone for severe susceptible enteric feverGive 2 g intravenously once daily for 10 to 14 days in severe typhoid or paratyphoid when susceptibility is expected or confirmed, with exact duration set clinically.
Azithromycin for uncomplicated enteric feverGive 500 mg orally once daily for seven days when a stable adult has uncomplicated susceptible-pattern infection and the specialist pathway selects azithromycin.