From the Guidelines
Treatment for salmonella in pediatric patients typically involves supportive care, with antibiotics reserved for specific situations, such as infants under 3 months, immunocompromised children, those with severe disease, bacteremia, or focal infections, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1. When antibiotics are necessary, the guidelines suggest considering treatment with ceftriaxone, ciprofloxacin, TMP-SMX, or amoxicillin, if susceptible, for 7-14 days depending on severity. Some key points to consider in the treatment of salmonella infections in pediatric patients include:
- Most healthy children with uncomplicated salmonella gastroenteritis should receive oral rehydration therapy, antipyretics for fever, and close monitoring rather than antibiotics, as the infection is usually self-limiting within 5-7 days.
- Antibiotics are indicated for high-risk groups, such as infants under 3 months, immunocompromised children, those with severe disease, bacteremia, or focal infections.
- Ceftriaxone (50-75 mg/kg/day IV) or ciprofloxacin (20-30 mg/kg/day divided twice daily) are commonly used for 7-14 days depending on severity.
- For oral therapy in less severe cases, amoxicillin (50-100 mg/kg/day divided three times daily) or trimethoprim-sulfamethoxazole (8-12 mg/kg/day of trimethoprim component divided twice daily) may be used.
- Ensure adequate hydration by encouraging oral fluids or using IV fluids if the child shows signs of dehydration.
- Probiotics may help reduce symptom duration.
- Parents should be educated about proper food handling and hygiene to prevent spread, and children should not return to daycare until diarrhea resolves and stool cultures are negative.
- Antibiotics are used selectively because they can prolong the carrier state and contribute to antibiotic resistance, as noted in the guidelines 1. It's also important to consider the potential risks and benefits of antibiotic treatment, as well as the possibility of antibiotic resistance, when making treatment decisions for pediatric patients with salmonella infections, as suggested by the guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment for Salmonella Infections in Pediatric Patients
- The treatment for Salmonella infections in pediatric patients typically involves the use of antibiotics, particularly for severe cases or in patients with certain risk factors 2, 3, 4, 5.
- Ceftriaxone and ciprofloxacin are commonly recommended antibiotics for the treatment of salmonellosis in children 2, 3, 5.
- Azithromycin is preferred for infections due to Shigella and Campylobacter, but not typically used for Salmonella infections 3, 5.
- Antibiotic treatment is not recommended for mild to moderate gastroenteritis caused by non-typhoidal Salmonella in immunocompetent children over 1 year of age 6, 4.
- However, antibiotic treatment is recommended for non-typhoidal Salmonella infections in infants less than 3 months of age, as they are at higher risk for bacteremia and extraintestinal complications 4.
Special Considerations
- The use of antibiotics in non-typhoidal Salmonella infections in children is still debated, with concerns about prolonged post-convalescent shedding 6.
- However, a systematic review found no substantial evidence of prolonged excretion of non-typhoidal Salmonella in pediatric patients after treatment with newer antimicrobials 6.
- Clinicians should not withhold antibiotics in non-typhoidal Salmonella infection for children at risk, such as very young children, children with comorbidities, and those with suspected invasive disease 6.