enteric fever

A 7year old boy with fever and vomiting for 3 days with hepatomegaly (4cm below rcm) showed up in my clinic . Lab : CBC - wnl; Malaria parasite slide and dual antigen negative; urine re/me - micro organism +, pus cell - 2-3/jpg, no RBC ; typhidot igm - positive. Started treatment for typhoid with cefixime and ofloxacin and other supportive medicines. 4 days passed. Vomiting subsided, child is able to take feeds well. Fever is still coming . Every night at 3am. 103°F. What should I do further? Opinions and comments on follow up please. What is the next line of treatment? I adviced as follows.: To continue same medicines for next 48 hours. If fever not subsided then do a blood C/S and take off ofloxacin and start corrimixazole. Any advice would be great

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In typhoid fever takes 7 days to 10 days to subside . Blood c/s though a gold standard in typhoid usually not done . These multi drug typhoid is rampant . And azithromycin with inj ceftriaxone or oral cefixime is becoming drug of choice . It enters the macrophages n kill the bacilli . To b given for 5 days at a dose of 20 mg /kg/day . Even cefixime n ofloxacin should b prescribed at a dose of 20 mg/kg/day . Plus dont combine azithromycin with fluoroquinolone it leads to prolonged qt interval .

Valuable opinion Sir
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Sir , rule out other infection/ especially atypical ones/ Kawasaki disease. I had seen one case in my residency.It was resistant to ceftriaxone , but responsive to meropenem....please read about ceftriaxone resistant enteric Fever

Thank you doctor
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R/O, dengue, brucellosis, rickettsial,& resistant enteric fever

Tq.dr.Pooja.L.
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SINCE... THERE. IS. CONTINUOUS. FEVER....DESPITE. TREATMENT.. DAILY... ONLY .....AT. NIGHT..AT. 3..A M.. SO...THERE. ARE. STRONG. CHANCES. OF... ... MALARIA.. ADVISABLE... ADD.... ...ARTHEMETER. PLUS... AND .. P. C M...

Checked for malaria sir. It's negative.
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