Immunizations American Academy of Family Physicians旅游免疫接种美国家庭医生学院课件.pptVIP

下载本文档

4
0
约5.03万字
约 79页
2018-06-22 发布于贵州
举报
版权申诉

Immunizations American Academy of Family Physicians旅游免疫接种美国家庭医生学院课件.ppt

1、本文档共79页，可阅读全部内容。
2、原创力文档（book118）网站文档一经付费（服务费），不意味着购买了该文档的版权，仅供个人/单位学习、研究之用，不得用于商业用途，未经授权，严禁复制、发行、汇编、翻译或者网络传播等，侵权必究。
3、本站所有内容均由合作方或网友上传，本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺！文档内容仅供研究参考，付费前请自行鉴别。如您付费，意味着您自己接受本站规则且自行承担风险，本站不退款、不进行额外附加服务；查看《如何避免下载的几个坑》。如果您已付费下载过本站文档，您可以点击这里二次下载。
4、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等，请点击“版权申诉”（推荐），也可以打举报电话：400-050-0827(电话支持时间：9:00-18:30)。
5、该文档为VIP文档，如果想要下载，成为VIP会员后，下载免费。
6、成为VIP后，下载本文档将扣除1次下载权益。下载后，不支持退款、换文档。如有疑问请联系我们。
7、成为VIP后，您将拥有八大权益，权益包括：VIP文档下载权益、阅读免打扰、文档格式转换、高级专利检索、专属身份标志、高级客服、多端互通、版权登记。
8、VIP文档为合作方或网友上传，每下载1次，网站将根据用户上传文档的质量评分、类型等，对文档贡献者给予高额补贴、流量扶持。如果你也想贡献VIP文档。上传文档

Immunizations American Academy of Family Physicians旅游免疫接种美国家庭医生学院课件

* Typhoid is most common in Southeast Asia and has the highest drug resistance. A traveler can acquire typhoid in less than a week in endemic area. * A transient macular rash of rose-colored spots frequently appears on trunk. Low-grade septicemia – blood culture is only positive in half of cases. GI bleeding secondary to ileocecal lymphatic hyperplasia of Peyer’s patches Also can have diarrhea, pneumonia, encephalitis, endocarditis and many other symptoms /travel/yellowbook/2010/chapter-2/typhoid-paratyphoid-fever.aspx * Fluoroquinolones are considered first-line treatment for adults. According to Cochrane review, studies are small and varied but fluoroquinolones appeared better than chlorampenicol (used overseas, not in US). Typhoid resistance to fluoroquinolones common in subcontinent India. (/reviews/en/ab004530.html) Ceftriaxone (Rocephin?) can be used intramuscularly or intravenously. Older drugs may be used but have a high level of resistance (amoxicillin, trimethoprim/sulfamethoxazole, chloramphenicol) A Cochrane database review suggests azithromycin works well in areas with multi-drug resistance, such as in India (/reviews/en/ab006083.html) Steroids may help in severe febrile cases, but evidence is based on studies with chloramphenicol (which is less used since the use of fluoroquinolones and azithromycin increased) (Hoffman SL; Punjabi NH; Kumala S, et al. Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone. N Engl J Med 1984 Jan 12;310(2):82-8). Despite giving the “right” antibiotic, patients will remain febrile for 3 to 5 days. Patients may also feel worse after antibiotics started and the fever is diminishing. /vaccines/vpd-vac/typhoid/default.htm * Travelers should be cautioned about eating fruits and vegetables (washed in local water), and should drink bottled water. * Vivotif? NO protection against S. Paratyphi Not 100% protection Needs to be refrigerated Cannot give if on antibiotics wit