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 NICE NG51.
• There is evidence of systemic involvement or complications, including suspected septicaemia or extra-intestinal spread of infection NICE CG84.
• The patient is unable to tolerate oral therapy or requires intravenous fluid therapy due to dehydration or other complications NICE CG84.
• 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 NICE NG143.
• There is a need for specialist input for antibiotic choice, management of antibiotic resistance, or monitoring for complications NICE NG143,NICE NG51,NICE CG84.

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 NICE NG143,NICE NG51,NICE CG84.