This document presents a case study of a 21-year-old male diagnosed with typhoid fever, detailing his symptoms, laboratory findings, and comprehensive treatment plan. The patient was admitted with fever, body ache, and yellowish sclera, and was treated over six days with antibiotics and supportive care. It emphasizes the importance of prevention strategies, hygiene practices, and patient education regarding medication and lifestyle modifications to avoid typhoid transmission.

1. A Case Study On Typhoid
Fever
(SOAP)
- Ajita Sadhukhan
- Pharm D. 3rd year
- Roll No. : 1
- Enrolment No. : 150821207001

2. Definition
 Typhoid or Enteric Fever is an infectious feverish disease
caused by the bacterium Salmonella typhi (Salmonella
enterica Serovar Typhi ) and less commonly by
Salmonella paratyphi.
 Acute generalized infection of the reticulo-endothelial
system, intestinal lymphoid tissue and the gall bladder.
 The infection always comes from another human, either
an ill person or a healthy carrier of the bacterium. The
bacterium is passed on with water and foods and can
withstand both drying and refrigeration.
2

3. Patient Demographics:
 Patient I.P. No.: 17009875
 Patient O.P. No.: 17112877
 Age: 21 years
 Weight: 48 Kg
 Sex: Male
 Department: Male Medicine Ward
 Unit: 1
 Date of Admission: 14. 8. 17
 Date of Discharge: 21. 8. 17
3

4.  Reason For Admission: - Fever since 1 week
- body ache
- headache
- sclera slightly yellowish
- watery eyes
 Past Medical History: NAD
 Past Medication History: Patient had taken medication for fever at home.
 Family history: NAD
 Social history: student
 Previous allergies: none
 Pregnancy status: NAD
4

5. OBJECTIVES
PHYSICAL EXAMINATION:
 GENERAL: Decreased appetite, yellowish urination
 CVS: S1 S2 normal
 RS: AEBE clear
 CNS: oriented
 BP: 110/80 mm Hg
 PR: 79/min
 TEMP: 99 F
 RESPIRATION: 17/min
 PA: Soft
5

6. LAB. INVESTIGATION REPORTS [first day]
LABORATORY PARAMETERS OBSERVED VALUE NORMAL RANGE UNIT
Hb 14.0 11.5-18 g%
Neutrophils 69.6 40-70 %
Lymphocytes 45 20-40 /cu mm
Monocytes 04 2-10 /cu mm
ESR 45 1-20 mm/hr
Platelets 348000 1.5-4 /cu mm
ALT 55 <40 IU/L
6
 PS for MP: Malarial parasite not seen
 Widal Test: Positive
 HIV test: negative
OTHERS (2nd day)

7. ASSESSMENT:
PROVISIONAL DIAGNOSIS: Typhoid Fever
7

8.  A 21 year old male patient was admitted to Med. ward-1 with complaints of fever
since 1 week, body ache, headache, sclera slightly yellowish and watery eyes.
 Based on lab report, patient’s lymphocytes, ESR and ALT levels are abnormally
increased. Widal Test is Positive. Hence, patient was diagnosed with typhoid fever.
8

9. FINAL DIAGNOSIS:
Typhoid Fever
9

10. GOALS OF TREATMENT:10
• To reduce fever.
• To reduce body ache.
• To reduce headache.
• To reduce slightly yellowish sclera.
• To reduce watery eyes.

11. DAY 1
 Temperature: 99 F
 Pulse: 79/min
 SPO2: 98%
 B.P.: 110/80 mm Hg
 R: 17/min
 Adv. : CBC, PS for MP, Widal Test, HIV
11

12. Medication chart (day 1)
DRUG NAME ROUTE DOSE FREQUENCY INDICATION
Inj. Ceftriaxone +
Sulbactam
I.V. 1.5 g in 100 ml
NS
BD To treat typhoid
fever
Inj. Ranitidine I.V. 2 ml 1-1-1 To prevent
acidity
Inj. Ondanstron I.V. 4 mg TDS To prevent
emesis
Inj. NaCl +
(Optineuron)
Calcium
Pantothenate +
Cyanocobalamin +
Folic acid +
Niacinamide +
Pyridoxine + Thiamine
I.V. 3 ml 1-0-0 Electrolyte +
Calcium and
Vitamin B
complex
supplement
12

13. DAY 2
 Temperature: 100 F
 Pulse: 80/min
 SPO2: 98%
 B.P.: 110/80 mm Hg
 R: 18/min
13

14. Medication chart (day 2)
14
DRUG NAME ROUTE DOSE FREQUENCY INDICATION
Tab. Paracetamol P.O. 500 mg SOS
1-0-1
Analgesic, anti-
pyretic
Inj. Ceftriaxone +
Sulbactam
I.V. 1.5 g in 100 ml
NS
BD To treat typhoid
fever
Tab. Azithromycin P.O. 500 mg 1-0-0 typhoid fever
Inj. Ranitidine I.V. 2 ml 1-1-1 To prevent
acidity
Inj. Ondanstron + Inj.
DNS/NS
I.V. 4 mg + I pint TDS Nausea and
vomiting
Inj. NaCl +
(Optineuron)
Calcium
Pantothenate +
Cyanocobalamin +
Folic acid +
Niacinamide +
Pyridoxine + Thiamine
I.V. 3 ml 1-0-0 Electrolyte +
Calcium and
Vitamin B
complex
supplement

15. DAY 3
 Temperature: 98 F
 Pulse: 82/min
 SPO2: 98%
 B.P.: 120/80 mm Hg
 R: 20/min
15

16. Medication chart (day 3)
DRUG NAME ROUTE DOSE FREQUENCY INDICATION
Tab. Diclofenac +
Paracetamol
P.O. 50 mg SOS
1-0-1
Painkiller, anti-
pyretic
Inj. Ceftriaxone +
Sulbactam
I.V. 1.5 g in 100 ml NS BD To treat typhoid
fever
Tab. Azithromycin P.O. 500 mg 1-0-0 typhoid fever
Inj. Ranitidine I.V. 2 ml 1-1-1 To prevent acidity
Inj. Ondanstron + Inj.
DNS/NS
I.V. 4 mg + I pint TDS Nausea and
vomiting
Inj. NaCl + (Optineuron)
Calcium Pantothenate +
Cyanocobalamin + Folic
acid + Niacinamide +
Pyridoxine + Thiamine
I.V. 3 ml 1-0-0 Electrolyte +
Calcium and
Vitamin B complex
supplement
Syp. Cyprohaptadine +
Tricholine + Sorbitol
P.O 1 tsf 1-0-1 For allergic
reactions
16

17. DAY 4
 Temperature: normal
 Pulse: 86/min
 SPO2: 98%
 B.P.: 120/80 mm Hg
17

18. Medication chart (day 4)
DRUG NAME ROUTE DOSE FREQUENCY INDICATION
Tab. Diclofenac +
Paracetamol
P.O. 50 mg SOS
1-0-1
Painkiller, anti-
pyretic
Inj. Ceftriaxone +
Sulbactam
I.V. 1.5 g in 100 ml NS BD To treat typhoid
fever
Tab. Azithromycin P.O. 500 mg 1-0-0 Typhoid fever
Inj. Ranitidine I.V. 2 ml 1-1-1 To prevent acidity
Inj. Ondanstron + Inj.
DNS/NS
I.V. 4 mg + I pint TDS Nausea and
vomiting
Inj. NaCl + (Optineuron)
Calcium Pantothenate +
Cyanocobalamin + Folic
acid + Niacinamide +
Pyridoxine + Thiamine
I.V. 3 ml 1-0-0 Electrolyte +
Calcium and
Vitamin B complex
supplement
Syp. Cyprohaptadine +
Tricholine + Sorbitol
P.O 1 tsf 1-0-1 For allergic
reactions
18

19. DAY 5
 Temperature: normal
 Pulse: 90/min
 SPO2: 97%
 B.P.: 120/80 mm Hg
 RS: NAD
 CVS: NAD
 CNS: NAD
 Adv.: CST
19

20. DRUG NAME ROUTE DOSE FREQUENCY INDICATION
Tab. Diclofenac +
Paracetamol
P.O. 50 mg SOS
1-0-1
Painkiller, anti-pyretic
Inj. Ceftriaxone + Sulbactam I.V. 1.5 g in 100 ml NS BD To treat typhoid fever
Tab. Azithromycin P.O. 500 mg 1-0-0 Typgoid fever
Inj. Ranitidine I.V. 2 ml 1-1-1 To prevent acidity
Inj. Ondanstron + Inj. DNS/NS I.V. 4 mg + I pint TDS Nausea and vomiting
Inj. NaCl + (Optineuron)
Calcium Pantothenate +
Cyanocobalamin + Folic
acid + Niacinamide +
Pyridoxine + Thiamine
I.V. 3 ml 1-0-0 Electrolyte + Calcium
and Vitamin B
complex supplement
Syp. Cyprohaptadine +
Tricholine + Sorbitol
P.O 1 tsf 1-0-1 For allergic reactions
Tab. Paracetamol P.O. 500 mg SOS
1-0-1
Analgesic, anti-pyretic
Medication chart (day 5)

21. DAY 6
 Temperature: normal
 Pulse: 80/min
 SPO2: 99%
 B.P.: 110/70 mm Hg
 R: 17/min
 Adv. Discharge with medication for 7 days.
21

22. DRUG NAME ROUTE DOSE FREQUENCY INDICATION
Tab. Diclofenac +
Paracetamol
P.O. 50 mg SOS
1-0-1
Painkiller, anti-pyretic
Tab. Azithromycin P.O. 500 mg 1-0-0 Typhoid fever
Inj. Ranitidine I.V. 2 ml 1-1-1 To prevent acidity
Inj. Ondanstron + Inj. DNS/NS I.V. 4 mg + I pint TDS Nausea and vomiting
Inj. NaCl + (Optineuron)
Calcium Pantothenate +
Cyanocobalamin + Folic
acid + Niacinamide +
Pyridoxine + Thiamine
I.V. 3 ml 1-0-0 Electrolyte + Calcium
and Vitamin B
complex supplement
Syp. Cyprohaptadine +
Tricholine + Sorbitol
P.O 1 tsf 1-0-1 For allergic reactions
Tab. Rabeprazole +
Domperidone
P.O. 40 mg 1-0-1 GERD
Medication chart (day 6)

23. Discharge Medication chart (follow up after
7 days)
DRUG NAME ROUTE DOSE FREQUENCY INDICATION
Tab. Rabeprazole +
Domperidone
P.O. 40 mg 1-0-1 GERD
Tab. Azithromycin P.O. 500 mg 0-1-0 Typhoid fever
Syp. Cyprohaptadine +
Tricholine + Sorbitol
P.O 1 tsf 1-0-0 For allergic
reactions
Tab. NaCl +
(Optineuron)
Calcium
Pantothenate +
Cyanocobalamin +
Folic acid +
Niacinamide +
Pyridoxine + Thiamine
P.O. 10 mg 0-1-0 Calcium and
Vitamin B
complex
supplement
23

24. TREATMENT PLAN:
24

25. Non-pharmacological treatment:
Some common home remedies
 Mash a ripe banana along with 1 tablespoon honey and eat twice a day for a few
days.
Activity
 No specific limitations on activity are indicated.
 Rest is helpful, but mobility should be maintained if tolerable.
 The patient should be encouraged to stay home from work until recovery.
Diet
 Fluids and electrolytes should be monitored and replaced diligently.
 Oral nutrition with a soft digestible diet is preferable in the absence of abdominal
distension or ileus.
25

26. Pharmacological Treatment:
26

27. INTERVENTION/POINTS TO BE
COMMUNICATED WITH DOCTOR
SERIOUS → USE ALTERNATIVE
 Azithromycin + Ondansetron: Both increase QT interval on prolonged use. Avoid or
use alternative drug.
27

28. PATIENT COUNSELING:
28

29. About Disease:
 It is a curable disease.
Two main typhoid fever prevention strategies:
1. Vaccination
✓ Be vaccinated against typhoid while traveling to a country where typhoid is
common.
✓ Need to complete your vaccination at least one week before travel.
✓ Typhoid vaccines lose their effectiveness after several years so check with your
doctor to see if it is time for a booster vaccination.
29

30. 2. Avoid risky food and drinks
✓ Buy bottled drinking water or bring it to a rolling boil for one minute before drinking it.
✓ Ask for drinks without ice, unless the ice is made from bottled or boiled water. Avoid
Popsicles and flavored ices.
✓ Eat food that have been thoroughly cooked and that are still hot and steaming.
✓ Avoid raw vegetables and food that cannot be peeled like lettuce.
✓ When eat raw fruit and vegetables that can be peeled, peel yourself. Don’t eat the
peelings.
✓ Avoid foods and beverages from street vendors.
30

31. About Medications:
 Dose of drugs
 Frequency of dose
 Route of administrations such as I.V, I.M., t/d, s/c, P.O., S/L.
 Counselling regarding overdose (may cause toxicity), underdose
(submaximal or no response) and missing of dose of medication. E.G. If a
dose is missed, then the patient is to be advised to go for the next dose,
otherwise toxicity of drug may occur.
 Contraindications
 Drug interactions (drug-drug, drug-food)
31

32. Life Style Modifications:
SANITORY MEASURES:
 Sanitary disposal of human faeces and maintain fly-proof latrines.
 Provision of safe chlorinated water and avoid possible back-flow connections between water and
sewer systems.
 Educate the community regarding the importance of hand washing especially after defecating.
 Control of flies by screening, spraying with insecticides, and use of insecticidal baits and traps.
 Control fly breeding by frequent collection and disposal of garbage, and fly-control measures in
latrine construction and maintenance.
 Use scrupulous cleanliness in food preparation and handling; refrigerate as appropriate. Particular
attention should be directed to the proper storage of salads and other foods served cold. These
provisions apply equally to home and public eating places.
 If uncertain about sanitary practices, select foods that are cooked and served hot, and fruits peeled
by the consumer.
 Pasteurize or boil all milk and dairy products. Supervise the sanitary aspects of commercial milk
production, storage and delivery.
 Enforce suitable quality-control procedures in industries that prepare food and drink for human
consumption.
32

33. FOOD SAFETY:
 Contaminated food is another important vehicle for typhoid fever transmission.
 Appropriate food handling and processing is paramount and the following basic hygiene measures must be
implemented or reinforced during epidemics:
 Washing hands with soap before preparing or eating food;
 Avoiding raw food, shellfish, ice; eating only cooked and still hot food or re-heating it.
NATURAL REMEDIES:
 Complete bed rest is essential.
 Patient should be kept on a liquid diet of orange, barley juice and milk.
 Orange juice especially hastens recovery as it increases energy, promotes body resistance and increases
urinary output.
 Administer warm water enema regularly.
 Apply cold compress to head if temperature rises above 1030F
 Wrap the body and legs twice with a sheet wrung in cold water and then cover it with a warm material.
 The pack should be kept for an hour and renewed after every 3 hours.
 Hot water bottles may be applied to the sides of the body and feet.
 Fresh fruits and easily digestible foods can be given after temperature comes down to normal.
 Plain water or unsweetened lemon water can be used for drinking.
 Gradually start a well-balanced diet.
33

34. 34