From the Guidelines
The recommended treatment for salmonellosis typically involves supportive care rather than antibiotics in most cases. For healthy individuals with uncomplicated gastroenteritis, the focus is on maintaining hydration with oral rehydration solutions or, in severe cases, intravenous fluids. Antibiotics are generally not recommended for uncomplicated cases as they may prolong bacterial shedding and don't significantly shorten illness duration, as noted in a study on the management of infectious diarrhea 1. However, antibiotics are indicated for high-risk patients (infants, elderly, immunocompromised) or those with severe disease, invasive infection, or bacteremia.
When needed, common antibiotic choices include ciprofloxacin, which is the preferred agent according to guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents 1. The length of therapy for HIV-related Salmonella infection can vary, with 7-14 days of treatment being reasonable for patients with mild gastroenteritis and CD4+ counts >200 cells/µL, while a longer course of antibiotics may be recommended for those with advanced HIV disease 1. It's also important to consider the potential for antibiotic resistance and the impact of empirical therapy on the emergence of drug-resistant strains, as discussed in the practice guidelines for the management of infectious diarrhea 1.
Patients should rest, consume clear fluids, and gradually reintroduce bland foods as symptoms improve. Anti-diarrheal medications like loperamide should be avoided as they may prolong the infection. Most cases resolve within 4-7 days with proper hydration and rest. Prevention through proper food handling and handwashing is essential to avoid reinfection or transmission to others. In cases of Salmonella septicemia, long-term therapy may be required to prevent recurrence, with fluoroquinolones being a common choice for susceptible organisms 1.
From the FDA Drug Label
Typhoid Fever (Enteric Fever) caused by Salmonella typhi. The recommended treatment for salmonelosis, specifically typhoid fever, is ciprofloxacin.
- The treatment is indicated for Salmonella typhi.
- Ciprofloxacin is used to treat typhoid fever (enteric fever) 2.
From the Research
Complications of Salmonelosis
- Salmonellosis can lead to various complications, including gastroenteritis, bacteremia, septicemia, and focal infections, with severe cases potentially resulting in host mortality 3.
- The bacteria can also spread in the bloodstream, causing sepsis and requiring effective antimicrobial therapy; however, sepsis rarely occurs 4.
Treatment 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 5.
- 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 5.
- Alternative treatment may use azithromycin and imipenem in life-threatening systemic Salmonella infections 5.
- Aminoglycosides are considered ineffective in gastrointestinal salmonelloses 5.
Challenges in Treatment
- The emerging resistance to fluoroquinolones, production of extended-spectrum beta-lactamases, and the increase of multidrug-resistant Salmonella strains are major problems in the search for efficient antimicrobial therapy of Salmonella infection 5, 6.
- Overuse of antibiotics contributes to the emergence of drug-resistant Salmonella strains 3.
Control Strategies
- Salmonellosis control strategies are based on two fundamental aspects: (a) the reduction of prevalence levels in animals by means of health, biosecurity, or food strategies and (b) protection against infection in humans 4.
- Efforts to reduce transmission of Salmonella by food and other routes must be implemented using a One Health approach 4.
- Innovative control strategies include antibiotic adjuvants, small molecules, phages, attenuated vaccines, and probiotic therapies, which show huge potential in controlling Salmonella infection 3.