Pediatric Salmonella Infection Treatment & Management

  • Author: Archana Chatterjee, MD, PhD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Apr 27, 2010
 

Medical Care

Aspects of treatment in Salmonella infection include the following:

  • Salmonella gastroenteritis
    • For uncomplicated gastroenteritis caused by nontyphoidal Salmonella species, antimicrobial therapy is not indicated because it does not shorten the duration of illness and may prolong the duration of fecal excretion.
    • Treatment involves monitoring hydration status and intravenous (IV) therapy to correct electrolyte imbalance or restore intravascular volume.
    • Antidiarrheal agents may actually prolong GI transit time and the illness.
    • Antimicrobial agents and hospital admission may be recommended in Salmonella gastroenteritis in infants younger than 3 months, infants younger than 12 months with temperatures of more than 39°C and unknown blood culture results, and patients with hemoglobinopathies, human immunodeficiency virus (HIV) infection or other causes of immunosuppression, neoplasms, or chronic GI illnesses.
    • The recommended antibiotics for individuals at high risk for invasive disease include ampicillin, amoxicillin, and trimethoprim-sulfamethoxazole (TMP-SMZ). In areas with multidrug resistance, cefotaxime or ceftriaxone are recommended.
  • Treatment of invasive Salmonella disease (bacteremia, extraintestinal manifestations)
    • Empiric antimicrobial therapy should include a broad-spectrum cephalosporin (cefotaxime or ceftriaxone). Once susceptibilities are available, narrow-spectrum therapy includes ampicillin, amoxicillin, cefotaxime, ceftriaxone, chloramphenicol, TMP-SMZ, or a fluoroquinolone.
    • A 14-day course of antibiotics is recommended for patients with bacteremia.
    • Patients with localized infection, such as osteomyelitis or an abscess, or patients with bacteremia and HIV infections should receive 4-6 weeks of therapy.
    • For Salmonella meningitis, ceftriaxone or cefotaxime is recommended for 4 weeks or longer.
  • Enteric fever caused by S typhi infection
    • For S typhi infection, initial empiric therapy with ceftriaxone is recommended due to widespread resistance. If susceptible, chloramphenicol, ampicillin, or TMP-SMZ may be used. Duration of therapy should be 14 days.
    • In severe infection, parenteral therapy is indicated.
    • Use antipyretics with caution or not at all because they may cause precipitous drops in temperature and shock. Fever may last 5-7 days, even with appropriate therapy.
    • Relapse is common (≤ 15%), and patients must be re-treated.
    • A short course of high dose-corticosteroids may be involved in treatment of patients with life-threatening neurologic complications of enteric fever.
    • High-dose ampicillin or high-dose amoxicillin plus probenecid for 4-6 weeks has cured many chronic carriers. Ciprofloxacin is the drug of choice for adult carriers.[1]
  • Multidrug resistance
    • As many as 40% of nontyphoidal Salmonella (NTS) isolates in the United States are multidrug resistant, with increasing resistance to all Salmonella strains worldwide.[3] In particular parts of the world (ie, India, Pakistan, Egypt), multiply antibiotic-resistant strains of S typhi are reported. Travelers from these regions should be treated with a 7-day to 10-day course of ceftriaxone or 5-day to 7-day course of ciprofloxacin or ofloxacin.
    • Decreased ciprofloxacin susceptibility and ceftriaxone resistance has been reported in developing countries.[18, 19, 20]
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Surgical Care

Cholecystectomy may be curative in carriers with chronic gallbladder disease. Focal abscesses may require drainage.[3]

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Consultations

Consider consultation with a pediatric infectious disease specialist if the appropriate antibiotic for treatment or the length of treatment are questioned in patients with documented Salmonella infection. Consider surgical consultation for patients with enteric fever who appear to have complications such as intestinal perforation, splenic rupture, or pancreatitis.

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Diet

Restrict initial oral intake to electrolyte solutions, such as Pedialyte or clear liquids. Add solid foods only when the diarrhea appears to be improving and dehydration is not present. Initially, children can be started on a BRAT diet (ie, bananas, rice, applesauce, toast) and then slowly advanced to a regular diet as tolerated.

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Contributor Information and Disclosures
Author

Archana Chatterjee, MD, PhD  Professor of Pediatrics, Medical Microbiology and Immunology, and Pharmacy, Division of Pediatric Infectious Diseases, Chief of Division of Pediatric Infectious Diseases, Creighton University School of Medicine; Hospital Epidemiologist and Medical Director of Infection Control, Children's Hospital

Archana Chatterjee, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, International Society for Infectious Diseases, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Catherine O'Keefe, DNP, APRN  Assistant Professor of Nursing and Pediatric Nurse Practitioner, Pediatric Infectious Diseases, Creighton University Medical Center

Catherine O'Keefe, DNP, APRN is a member of the following medical societies: American Academy of Nurse Practitioners, National Association of Pediatric Nurse Practitioners, and Nebraska Nurse Practitioners

Disclosure: Nothing to disclose.

Meera Varman, MD  Associate Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University Medical Center

Meera Varman, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: phamaceutical companies Honoraria Speaking and teaching; phamaceutical companies Grant/research funds clinical trials

Specialty Editor Board

José Rafael Romero, MD  Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center

José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Larry I Lutwick, MD  Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

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Under a moderately-high magnification of 8000X, this colorized scanning electron micrograph (SEM) revealed the presence of a small grouping of gram-negative Salmonella typhimurium bacteria that had been isolated from a pure culture. Image courtesy of the Centers for Disease Control and Prevention, Bette Jensen, and Janice Haney Carr.
 
 
 
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