To the Editor.—Dr Zenilman1 is to be complimented both for reminding us of the importance of typhoid fever as one cause of a febrile infection in a patient returning from India and for his lucid, contemporary review of this severe systemic illness.
In the Grand Rounds at The Johns Hopkins Hospital presentation, therapy for typhoid fever focused exclusively on antimicrobial treatment, however, and omitted commentary regarding the administration of a glucocorticoid for treatment of the patient with shock or altered mental status. Based on 1 randomized, double-blind, placebo-controlled study, dexamethasone infusion was associated with enhanced survival when this glucocorticoid was administered to severely ill patients.2 This may be an exception to the rule that glucocorticoid administration is not indicated for patients with gram-negative sepsis or shock. Dexamethasone should be prescribed for only 48 hours, as prolonged therapy may increase the risk of relapse.
Gleckman R. Emerging Drug Resistance and Vaccination for Typhoid Fever. JAMA. 1998;279(8):580. doi:10.1001/jama.279.8.579a
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