What are the typical presentation and management of salmonelosis?

From the Guidelines

Salmonellosis typically presents as acute gastroenteritis with sudden onset of headache, abdominal pain, diarrhea, nausea, and vomiting, and most cases are self-limiting, requiring only supportive care. The symptoms of salmonellosis generally begin 6-72 hours after exposure and last 4-7 days, with fever usually ranging from 100-102°F 1. The management of salmonellosis includes:

• Supportive care with oral rehydration with fluids containing electrolytes, rest, and possibly anti-diarrheal medications like loperamide after the first 24 hours
• Antibiotics are not routinely recommended for uncomplicated cases as they may prolong bacterial shedding, but are indicated for severe disease, invasive infections, or high-risk patients (infants, elderly, immunocompromised) 1
• When needed, ciprofloxacin 500mg twice daily for 5-7 days or azithromycin 500mg daily for 3 days are commonly prescribed, with trimethoprim-sulfamethoxazole (160/800mg twice daily for 5-7 days) as an alternative 1
• Prevention involves proper food handling, thorough cooking of animal products, avoiding cross-contamination, and handwashing 1 Some key points to consider in the management of salmonellosis include:
• The risk of complications, such as bacteremia or invasive disease, is higher in certain populations, such as the elderly, immunocompromised individuals, and young children 1
• The use of antibiotics should be guided by susceptibility testing and should be tailored to the specific needs of the patient 1

From the Research

Typical Presentation of Salmonelosis

• Salmonellosis in humans is most often manifested as a self-limiting gastroenteritis 2
• Nontyphoidal Salmonella infection is usually characterized by a self-limited gastroenteritis in immunocompetent hosts in industrialized countries, but it may also cause invasive disease in vulnerable individuals 3
• The transmission of Salmonella to humans occurs through the farm-to-fork continuum and is commonly linked to the consumption of animal-derived food products 4

Management of Salmonelosis

• Antimicrobial therapy is superfluous in the milder forms of the disease and in Salmonella carriage but can be life saving for patients with septic salmonellosis and patients at risk of extraintestinal dissemination of the infection 2
• Antibiotic treatment is not recommended for treatment of mild to moderate gastroenteritis by nontyphoidal Salmonella in immunocompetent adults or children more than 1 year of age 3
• The choice of antibiotics for the management of typhoid fever should be guided by the local resistance pattern, with recommendations including using an extended spectrum cephalosporin, azithromycin, or a fluoroquinolone 3
• Azithromycin and ceftriaxone were found to be more effective in treating Salmonella infections based on the patient's length of stay in the hospital and the rate at which the fever was resolved 5

Treatment Options

• The drugs of choice for empiric treatment of acute infectious diarrhea, in which Salmonella spp are etiologically implicated, are fluoroquinolones in adults and third generation cephalosporins in children 2
• Alternative treatment may use azithromycin and imipenem in life-threatening systemic Salmonella infections 2
• Azithromycin was found to be the physicians' preferred choice of medication for Salmonella infection due to its less resistance development 5