From the Guidelines
Treatment for salmonella enteritis primarily involves supportive care, as most cases resolve without antibiotics within 4-7 days. The cornerstone of treatment is maintaining adequate hydration through oral rehydration solutions like Pedialyte or Gatorade, or in severe cases, intravenous fluids. Patients should rest and consume a bland diet (bananas, rice, applesauce, toast) while avoiding dairy, fatty, spicy, or high-fiber foods that may worsen symptoms.
Key Considerations
- Antibiotics are generally reserved for severe cases, high-risk patients (infants, elderly, immunocompromised), or those with invasive disease, as they can prolong the carrier state and contribute to antibiotic resistance 1.
- When needed, antibiotics such as ciprofloxacin, azithromycin, or trimethoprim-sulfamethoxazole may be prescribed, but the choice of antimicrobial agent may change due to evolving resistance patterns 1.
- Anti-diarrheal medications like loperamide should be avoided as they can prolong bacterial shedding.
- Fever can be managed with acetaminophen (650mg every 4-6 hours, not exceeding 4g daily).
Prevention of Transmission
- Proper handwashing and food safety practices are essential to prevent transmission to others, as patients remain contagious until diarrhea resolves and sometimes for weeks afterward.
- It is crucial to note that several RCTs have demonstrated a small but significant benefit for antimicrobial therapy in reducing the duration of symptoms in certain cases, but the risks of treatment often outweigh the benefits, especially in cases of salmonellosis 1.
From the FDA Drug Label
Infectious Diarrhea caused by Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, Shigella boydii†, Shigella dysenteriae, Shigella flexneri or Shigella sonnei† when antibacterial therapy is indicated. Typhoid Fever (Enteric Fever) caused by Salmonella typhi.
The treatment for salmonella enteritis is ciprofloxacin (PO), as it is indicated for the treatment of Typhoid Fever (Enteric Fever) caused by Salmonella typhi 2.
From the Research
Treatment Options for Salmonella Enteritis
- The treatment of salmonella enteritis typically depends on the severity of the disease and the patient's immune status 3.
- For mild cases, antimicrobial therapy may not be necessary, while for severe cases or patients at risk of extraintestinal dissemination, antimicrobial therapy can be life-saving 3.
- The choice of antibiotic depends on the patient's age, with fluoroquinolones recommended for adults and third-generation cephalosporins for children 3.
- Alternative treatments include azithromycin and imipenem for life-threatening systemic salmonella infections 3.
Efficacy of Different Antibiotics
- A systematic review found that azithromycin and ceftriaxone were more effective in treating salmonella infections compared to other antibiotics 4.
- The review also found that azithromycin was the preferred choice of medication due to its lower resistance development and safer side effect profile 4.
- However, another study found that azithromycin and cefixime provided no benefit in treating uncomplicated salmonella enteritis in children 5.
- A controlled human infection model study found that azithromycin was associated with prolonged bacteraemia and fever clearance times compared to ciprofloxacin 6.
Role of Quinolone Antibiotics
- Quinolone antibiotics, such as ciprofloxacin, have been shown to be effective in treating salmonella infections, including enteric fever and salmonella enterocolitis 7.
- These antibiotics can shorten the course of clinical disease and terminate excretion of salmonellae in the stool 7.
- Quinolones may also be effective in eradicating biliary and fecal reservoirs of infection in chronic carriers of salmonella strains 7.