From the Guidelines
The recommended treatment for pediatric salmonella gastroenteritis is primarily supportive care with a focus on preventing and treating dehydration through oral rehydration therapy using solutions like Pedialyte or WHO oral rehydration solution. Antibiotics are generally not recommended for uncomplicated cases as they may prolong the carrier state and contribute to antibiotic resistance 1. However, antibiotics are indicated for infants under 3 months, immunocompromised children, those with severe disease, or systemic spread. When needed, appropriate antibiotics include ceftriaxone, ciprofloxacin, TMP-SMX, or amoxicillin, as suggested by the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1. Parents should be advised to practice meticulous hand hygiene, keep the child well-hydrated, watch for signs of worsening dehydration (decreased urination, dry mouth, lethargy), and seek immediate medical attention if the child develops high fever, bloody diarrhea, or signs of severe dehydration. The rationale for limited antibiotic use is that Salmonella infections are typically self-limiting within 5-7 days, and unnecessary antibiotics can disrupt gut flora and select for resistant organisms. Additional guidance from other studies, such as those published in 2002 1, 2000 1, and 2000 1, support the use of antibiotics in specific cases, such as HIV-infected children or those with severe immunosuppression, but the most recent and highest quality guidelines are from 2017 1. Key points to consider in the treatment of pediatric salmonella gastroenteritis include:
- Supportive care with oral rehydration therapy
- Limited use of antibiotics to prevent resistance and disruption of gut flora
- Antibiotic treatment for high-risk groups, such as infants under 3 months or immunocompromised children
- Monitoring for signs of worsening dehydration and seeking immediate medical attention if necessary
- Practicing meticulous hand hygiene to prevent the spread of infection.
From the Research
Treatment of Salmonella Gastroenteritis in Pediatrics
The treatment of pediatric salmonella gastroenteritis depends on various factors, including the severity of the infection, the age of the child, and the presence of any underlying medical conditions.
- For mild to moderate gastroenteritis caused by nontyphoidal Salmonella in immunocompetent children over 1 year of age, antibiotic treatment is not recommended 2.
- However, for infants less than 3 months of age, antibiotic treatment is recommended due to the higher risk of bacteremia and extraintestinal complications 2.
- Azithromycin and ceftriaxone have been shown to be effective in treating Salmonella infections, with azithromycin being a preferred choice due to its lower resistance development 3.
- Fluoroquinolones, such as ciprofloxacin, are also effective but are not approved for use in children 3, 2.
- A study comparing azithromycin and ciprofloxacin in the treatment of uncomplicated Salmonella Typhi infection found that azithromycin was associated with prolonged bacteraemia and fever clearance times 4.
- Another study found that ampicillin and amoxicillin therapy provided no benefit to patients with uncomplicated Salmonella gastroenteritis and substantially increased the risk of bacteriologic and symptomatic relapse 5.
Antibiotic Susceptibility
- The susceptibility of non-typhoidal Salmonella to various antibiotics, including ampicillin, norfloxacin, and co-trimoxazole, has been reported in several studies 6.
- Serogroup B was found to be the most resistant strain, with low susceptibility to ampicillin but high susceptibility to norfloxacin and co-trimoxazole 6.