A Case On Typhoid Fever: Group 4
A Case On Typhoid Fever: Group 4
A Case On Typhoid Fever: Group 4
Group 4
Baccay, Ezra Kimraja
Clemente, Kristine Jane
Lasam, Janine Marie
Padilla, Jiane Karla
Pattaguan, Donesthel
Tabugay, Lolaine
Vargas, Aige
Demographics
Name
N.P.
Age/Sex
Ward Number
17 y/o F
SA46
Resident-In-Charge
Chief Complaint
Fever change in sensorium
History of Present Illness
7 Days Prior to 3 Days Prior to Few Hours Prior to
Consult Consult Consult
01 02 03 04 05
Drowsy, confused
Anicteric sclerae Tachycardia, Full (+) Pallor SLE, CBS
pulses (-) Jaundice
Laboratory Results
Vital Signs
Vital Signs 04-14-18 04-15-18 04-16-18 Interpretation
N 110/80 110/80 110/80
Blood
A 110/80 110/80 110/80 *Normal
Pressure
P 110/80 110/80 110/70
N 92 94 96
*Slightly
Heart Rate A 98 91 100 Increased
04-16-18
P 86 90 120
N 22 20 24
Respiratory
A 22 20 21 *Normal
Rate
P 20 20 26
N 36.1 36.3 36.8
Temperature A 36 36.5 36.1 *Normal
P 36.5 37.2 36
Laboratory Results
Hematology
Hematology 04-02-18 04-10-18 Interpretation
Slightly
HCT 39-54% 40 37 Decreased
04-10-18
Normal (except
WBC 5.0-10.0x109/L 12.34 10.30
04-02-18)
CXR Pneumonia
04-12-18 R Parahilar area
Present Working Impression
Typhoid Fever
Typhoid Encephalopathy
Medications and Indications
For Severe Typhoid Fever
Phenobarbital
+ Dibencozide
Phenobarbital decreases level of Dibencozide
by inhibition of GI absorption
Intervention:
• Relapse rate is much lower following treatment
with quinolone drugs which has effective
intracellular penetration. A dose of Ciprofloxacin
500mg/tab orally 2x/day for 7-10 days can be
given.
• After discharge, relapse or complication should
be monitored for 3 months.
Possibility of Reference:
Medscape
The Phil Working Group Drug
Subj. toxic:
Watch out for SE No occurrence Daily
Ceftriaxone of SE
Swelling of
Tongue
Vaginal itching
Pharmacist’s Care Plan
Health Care Pharmacotherapeutic Recommendation/Inte Monitoring Desired
Frequency
Need Goal rvention Parameter EndPoint
Obj. therapeutic:
ELISA
b.) To manage Severe
(-) Salmonella
Typhoid Complication Q 3 mos.
Subj. toxic: Antibody
1.) To treat Typhoid Compliance with
Watch our for
Management encephalopathy Phenobarbital 60mg tab
SE:
of Typhoid 1 tab BID
Mannitol No occurrence
Fever To decrease Daily
Electrolyte of SE
intracranial Compliance with
imbalance
pressure Mannitol 100cc q12h
Phenobarbital
Hangover
effect
Subj.
Compliance with:
therapeutic:
c.) To increase Dibencozide
(-) poor appetite (-) poor
appetite (Heraclene) 1mg 1 cap Daily
due to typhoid appetite
OD
fever
Pharmacist’s Care Plan
Health Care Pharmacotherapeuti Recommendation/Int Monitoring Desired
Frequency
Need c Goal ervention Parameter EndPoint
Obj.
therapeutic:
Urinalysis Daily
C/S No bacterial Q after 2
Gram stain growth days
2.)
To prevent Compliance with Q after 2
Prevention of
recurrence and Ciprofloxacin 500mg Subj. toxic: days
Typhoid
further infection tab BID for 7-10 days Ciprofloxacin No occurrence
Fever
Severe of S.E.
dizziness Daily
Bloody
diarrhea
Pharmacist’s Notes
To Doctor
Re: Patient N.P. Ward and Room Number: 5A46 Date: April 17, 2018
Recommendation:
We would like to recommend to increase the dose of
Dibencozide(Heraclene) from 1mg to 3mg when concomitantly use with
Phenobarbital
Discussion:
Phenobarbital decreases level of Dibencozide by inhibition of GI
absorption
Reference: Medscape
Pharmacist’s Notes
To Doctor
Re: Patient N.P Ward and Room Number: 5A46 Date: April 17, 2018
Recommendation:
We would like to recommend an initiation of Ciprofloxacin 500mg tab
BID for 7-10 days for prevention of relapse.
Discussion:
Possibility of relapse of typhoid fever may occur in rare cases. A
relapse rate is much lower following treatments with Quinolone drug, which
has effective intracellular penetration. Example of which is Ciprofloxacin.
Reference: Medscape,
The Phil Working Group on
Drug Resistant Typhoid
Fever
Pharmacist’s Notes
To Nurse
Re: Patient N.P Ward and Room Number: 5A46 Date: April 17, 2018
Recommendation:
We would like to recommend a follow up check up after 3 months to
monitor relapse or recurrence of typhoid fever.
Discussion:
Possibility of relapse of typhoid fever may occur in rare cases. As
such 2nd or 3rd relapse can occur. Monitoring after 3 months is a must to
prevent the spread of infection
Reference: Medscape
References
Medscape.com
A
Drugs.com B D Lexicomp