What is the best antibiotic treatment for salmonella?

From the Guidelines

The best antibiotic treatment for salmonella typically involves azithromycin (500 mg once daily for 5-7 days) for uncomplicated cases in adults, considering the increasing resistance to ciprofloxacin in many parts of the world, as noted in studies such as 1 and 1. For children, ceftriaxone (50-100 mg/kg/day) or azithromycin (10 mg/kg on day 1, then 5 mg/kg for 4 days) are preferred options. However, many uncomplicated salmonella infections, particularly gastroenteritis, often don't require antibiotics and resolve with supportive care including hydration and rest. Some key points to consider in the treatment of salmonella infections include:

• Antibiotics are primarily indicated for severe infections, invasive disease, or in high-risk patients (infants, elderly, immunocompromised individuals) as suggested by 1.
• Treatment choice should consider local resistance patterns, as salmonella has developed resistance to multiple antibiotics, a concern highlighted in 1 and 1.
• During treatment, patients should maintain good hydration, complete the full course of antibiotics if prescribed, and practice strict hand hygiene to prevent transmission to others.
• The use of fluoroquinolones like ciprofloxacin is cautioned against in certain cases due to resistance, especially in travelers returning from areas like India, as mentioned in 1 and 1.
• Azithromycin has been shown to be effective against salmonella and is a suitable alternative in cases of fluoroquinolone resistance, as discussed in 1 and 1.

From the FDA Drug Label

Typhoid Fever (Enteric Fever) caused by Salmonella typhi.

The best antibiotic treatment for salmonella is ciprofloxacin 2.

From the Research

Antibiotic Treatment for Salmonella

The best antibiotic treatment for salmonella depends on the severity of the infection and the patient's immune status.

• For adults, fluoroquinolones are often the drug of choice for empiric treatment of acute infectious diarrhea caused by Salmonella spp 3.
• For children, third-generation cephalosporins are preferred 3.
• Alternative treatments include azithromycin and imipenem for life-threatening systemic Salmonella infections 3.
• Aminoglycosides are considered ineffective in gastrointestinal salmonelloses 3.

Treatment Responses to Azithromycin and Ciprofloxacin

Studies have compared the treatment responses to azithromycin and ciprofloxacin in uncomplicated Salmonella Typhi infection:

• Azithromycin was associated with prolonged bacteraemia and fever clearance times compared to ciprofloxacin 4.
• Ciprofloxacin was found to be more effective in eliminating extracellular circulating S. Typhi 4.
• Azithromycin at a dose of 500mg daily is effective for fully sensitive strains of S. Typhi but may be associated with delayed treatment response and prolonged bacteraemia 4.

Quinolone Antibiotics

Quinolone antibiotics, such as ciprofloxacin, have been shown to be effective against Salmonella infections:

• They possess broad in vitro antibacterial activity, including efficacy against enteric pathogens such as Salmonella, Shigella, Campylobacter, Yersinia, and Vibrio species 5.
• Quinolones can shorten the course of clinical disease and terminate excretion of Salmonella in the stool 5.
• However, there are increasing reports of treatment failures with ciprofloxacin in typhoid fever caused by typhoid salmonellae with reduced susceptibility to ciprofloxacin 6.

Antimicrobial Resistance

Antimicrobial resistance is a growing concern in the treatment of Salmonella infections:

• There is an increase in the occurrence of strains resistant to ciprofloxacin 7.
• Extended-spectrum cephalosporins and azithromycin are alternative options for the treatment of enteric fever 7.
• The emergence of broad-spectrum β-lactamases in typhoidal salmonellae constitutes a new challenge 7.