1681 1682 The control or elimination of typhoid fever is well within 1683 the scope of modern public health. This is an accomplished 1684 fact in many developed countries. There are generally three 1685 lines of defence against typhoid fever : 1686 1687 1. control of reservoir 1688 1689 2. control of sanitation, and 1690 1691 3. immunization. 1692 1693 The weakest link in the chain of transmission is sanitation which is amenable to control. 1694 1695 1696 ## 1. Control of reservoir 1697 1698 The usual methods of control of reservoir are their 1699 identification, isolation, treatment and disinfection. 1700 1701 1702 ## a. CASES 1703 1704 (i) Early diagnosis : This is of vital importance as the early 1705 symptoms are non-specific. Culture of blood and stools are 1706 1707 important investigations in the diagnosis of cases. 1708 (ii) Notification: This should be done where such notification is mandatory. (iii) Isolation : Since typhoid fever is infectious and has a prolonged course, the cases are better transferred to a hospital for proper treatment, as well as to prevent the spread of infection. As a rule, cases should be isolated till three bacteriologically negative stools and urine reports, are obtained on three separate days. (iv) Treatment : The fluoroquinolones are widely regarded as the drug of choice for the treatment of typhoid fever. They are relatively inexpensive, well tolerated and more rapidly and reliably effective than the former first-line drugs, viz. chloramphenicol, ampicillin, amoxicillin and trimethoprim – sulfamethoxazole (TMP-SMX). The antibiotics used in uncomplicated typhoid fever are as shown in Table 1. Patients seriously ill and profoundly toxic may be given an injection of hydrocortisone 100 mg daily for 3 to 4 days. (v) Disinfection : Stools and urine are the sole sources of infection. They should be received in closed containers and disinfected with 5 per cent cresol for at least 2 hours. All soiled clothes and linen should be soaked in a solution of 2 per cent chlorine and steam–sterilized. Nurses and doctors should not forget to disinfect their hands. (vi) Follow-up : Follow-up examination of stools and urine should be done for S. typhi 3 to 4 months after discharge of the patient, and again after 12 months to prevent the development of the carrier state. With early diagnosis and appropriate treatment, mortality has been reduced to about 1 per cent as compared to about 30 per cent in untreated cases. 1709 1710 1711 ## (b) CARRIERS 1712 1713 Since carriers are the ultimate source of typhoid fever, their identification and treatment is one of the most radical ways of controlling typhoid fever. The measures recommended are : (i) Identification : Carriers are identified by cultural and serological examinations. Duodenal drainage establishes the presence of salmonella in the biliary tract in carriers. The Vi antibodies are present in about 80 per cent of chronic carriers. (ii) Treatment : The carrier should be given an intensive course of ampicillin or amoxyccillin (4–6 g a day) together with Probenecid (2 g/day) for 6 weeks. These drugs are concentrated in the bile and may achieve eradication of the carrier state in about 70 per cent of carriers. Chloromycetin is considered worthless for clearing the carrier state. (iii) Surgery : Cholecystectomy with concomitant ampicillin therapy has been 1714 1715 1716 ## TABLE 1 1717 1718 Treatment of uncomplicated typhoid fever 1719 1720 1721

Susceptibility	Optimal therapy			Alternative effective drugs
	Antibiotic	Daily dose mg/kg	Days	Antibiotic	D [... Output truncated due to length. 1971 tokens/6561 characters removed ...]