From the Guidelines
Treatment for salmonella infections with symptoms lasting greater than one week typically requires antibiotic therapy, with fluoroquinolones like ciprofloxacin or levofloxacin being first-line treatments for adults, and azithromycin or ceftriaxone for children. The choice of antibiotic and duration of treatment depend on the severity of the infection, the patient's age, and the presence of underlying medical conditions. According to the guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents, for patients with CD4+ counts >200 cells/µL and mild gastroenteritis, with or without bacteremia, 7--14 days of treatment for salmonellosis is reasonable 1. However, for patients with advanced HIV disease (CD4+ count <200 cells/µL), a longer course of antibiotics (e.g., 2--6 weeks) is often recommended 1.
Some key points to consider when treating salmonella infections include:
- The use of antibiotics to reduce the duration and shedding of organisms in infections with susceptible species 1
- The risk of quinolone-resistant Campylobacter infections and the potential for quinolone resistance to develop during treatment 1
- The importance of fluid replacement to prevent dehydration and the need for patients to continue the full course of antibiotics even if symptoms improve
- The need for patients to avoid preparing food for others until cleared by follow-up testing and to practice strict handwashing to prevent secondary transmission 1
In terms of specific treatment options, fluoroquinolones like ciprofloxacin (500-750 mg twice daily for 7-14 days) or levofloxacin (500 mg once daily for 7-14 days) are commonly used to treat salmonella infections in adults. Alternative options include trimethoprim-sulfamethoxazole (160/800 mg twice daily for 7-14 days) or azithromycin (500 mg daily for 5-7 days). For children, azithromycin (10 mg/kg daily for 5-7 days) or ceftriaxone (50-100 mg/kg daily for 7-14 days) may be used. It is essential to note that the treatment should be guided by the most recent and highest quality study, and the choice of antibiotic should be based on the susceptibility of the organism and the patient's clinical condition.
From the FDA Drug Label
Typhoid Fever (Enteric Fever) caused by Salmonella typhi. The usual duration is 7 to 14 days; however, for severe and complicated infections more prolonged therapy may be required.
The treatment for Salmonella infections with symptoms lasting greater than one week is ciprofloxacin (PO), with a treatment duration of 7 to 14 days or more, depending on the severity of the infection 2.
- Dose: 500 mg every 12 hours
- Duration: at least 10 days for typhoid fever, but may be longer for complicated infections 2.
From the Research
Treatment for Salmonella Infections with Symptoms Lasting Greater than One Week
- The treatment for salmonella infections with symptoms lasting greater than one week depends on the severity of the infection and the patient's immune status 3, 4.
- For mild to moderate gastroenteritis caused by nontyphoidal salmonella in immunocompetent adults or children over 1 year of age, antibiotic treatment is not recommended 3.
- However, for infants less than 3 months of age, antibiotic treatment is recommended due to the higher risk of bacteremia and extraintestinal complications 3.
- For typhoid fever, antibiotic treatment is recommended, and the choice of antibiotics should be guided by the local resistance pattern 3.
- Fluoroquinolones, azithromycin, and third-generation cephalosporins are effective antimicrobial agents for the treatment of salmonella infections 4, 5.
- The duration of treatment for salmonella infections can vary, but it is typically recommended for 12-26 days, depending on the severity of the infection and the patient's response to treatment 6.
- In some cases, such as in immunocompromised patients or those with invasive disease, longer treatment durations may be necessary 6, 5.
- It is essential to note that antibiotic treatment can prolong the excretion of salmonella and does not shorten the duration of gastrointestinal symptoms in patients with gastroenteritis 5.