When should I consider referring a patient with typhoid fever to secondary care for further management?

Consider referring a patient with typhoid fever to secondary care for further management if any of the following apply:

• The patient shows signs of severe infection or suspected sepsis, such as shock, unresponsiveness, or other high-risk clinical features requiring urgent assessment and intravenous antibiotics within 1 hour ².
• There is evidence of systemic involvement or complications, including suspected septicaemia or extra-intestinal spread of infection ³.
• The patient is unable to tolerate oral therapy or requires intravenous fluid therapy due to dehydration or other complications ³.
• The patient is a child with persistent fever and no clear diagnosis, or with red or amber features indicating risk of serious illness, or if social/family circumstances or parental anxiety suggest the need for hospital assessment ¹.
• There is a need for specialist input for antibiotic choice, management of antibiotic resistance, or monitoring for complications ¹,²,³.

In summary, referral is warranted when the patient is clinically unstable, has signs of severe or complicated infection, cannot be managed safely in the community, or requires specialist assessment and treatment ¹,²,³.