Medical Care
Aspects of treatment in Salmonella infection include the following:
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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.
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Treatment of invasive Salmonella disease (bacteremia, extraintestinal manifestations)
Empiric antimicrobial therapy should include a broad-spectrum cephalosporin (cefotaxime or ceftriaxone). Once susceptibilities are available, narrower-spectrum therapy includes ampicillin, amoxicillin, as well as broader-spectrum agents such as 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.
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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. [5]
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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. [7] 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. [33, 34, 35, 36]
Surgical Care
Cholecystectomy may be curative in carriers with chronic gallbladder disease. Focal abscesses may require drainage. [7]
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.
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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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.
