From the FDA Drug Label
To minimize the potential for gastrointestinal intolerance, amoxicillin should be taken at the start of a meal. Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained
The recommended duration of amoxicillin treatment for gastrointestinal infections such as salmonella or gastritis is not explicitly stated in the label. However, the general guideline is to continue treatment for a minimum of 48 to 72 hours beyond the time the patient becomes asymptomatic or evidence of bacterial eradication is obtained.
- The label does provide specific treatment durations for other infections, such as 10 days for infections caused by Streptococcus pyogenes to prevent acute rheumatic fever, and 14 days for H. pylori infection.
- It is essential to note that amoxicillin may cause gastrointestinal intolerance, and taking it at the start of a meal can help minimize this risk. 1
From the Research
For gastritis caused by Salmonella infection, the recommended approach is to avoid antibiotic treatment with amoxicillin due to the risk of bacteriologic and symptomatic relapse, as shown in a study from 2, and instead consider supportive care for uncomplicated cases. When considering antibiotic treatment, the choice of antibiotic and duration of treatment should be guided by the severity of the infection, the patient's risk factors, and antibiotic susceptibility testing.
- The most recent and highest quality study, 3, found that azithromycin and ceftriaxone were more effective in treating Salmonella infections, with azithromycin being the preferred choice due to its lower risk of resistance development.
- Fluoroquinolones, such as ciprofloxacin, are also effective in treating Salmonella infections, but their use is not approved in children, as noted in 4 and 5.
- The use of amoxicillin, as studied in 2, is not recommended due to the high risk of bacteriologic and symptomatic relapse.
- Antibiotic treatment for Salmonella gastritis is generally reserved for severe cases, high-risk patients (immunocompromised, elderly, infants), or cases with systemic spread, as most uncomplicated Salmonella gastroenteritis is self-limiting and resolves within 5-7 days with supportive care (hydration and electrolyte replacement).
- It is crucial to complete the full course of antibiotics to prevent recurrence and antibiotic resistance, and antibiotic susceptibility testing is important before initiating treatment due to increasing resistance patterns worldwide.