How do you treat salmonella gastroenteritis?

Treatment of Salmonella Gastroenteritis

Antibiotics are generally not recommended for uncomplicated Salmonella gastroenteritis in immunocompetent individuals, as they may prolong the carrier state without improving clinical outcomes.

Treatment Approach Based on Patient Factors

Immunocompetent Adults and Children with Uncomplicated Disease

• Supportive care only is recommended:
  • Oral rehydration with electrolyte solutions
  • Resumption of age-appropriate diet as tolerated
  • Strict hand hygiene to prevent transmission
  • Avoid antimotility agents, especially if high fever or bloody stools 1

High-Risk Populations Requiring Antibiotic Treatment

Antibiotics should be administered to:

1. Immunocompromised patients:

   • HIV-infected persons (especially CD4+ <200 cells/μL) 1
   • Transplant recipients
   • Patients on immunosuppressive medications

2. Infants and young children:

   • HIV-exposed infants <3 months of age 1
   • All HIV-infected children with severe immunosuppression 1
   • Infants ≤3 months of age (even without HIV) due to high risk of complications 2

3. Pregnant women - to prevent extraintestinal spread to placenta and amniotic fluid 1

4. Patients with severe disease:

   • High fever (>38.5°C)
   • Bloody diarrhea
   • Severe dehydration
   • Systemic symptoms

5. Patients with evidence of invasive disease or bacteremia 1

Antibiotic Selection

First-line therapy:

• Adults: Fluoroquinolones (ciprofloxacin 750 mg twice daily for 14 days) 1
• Children: Third-generation cephalosporins (ceftriaxone, cefotaxime) 1, 3
• Pregnant women: Ampicillin, cefotaxime, ceftriaxone, or TMP-SMZ 1

Alternative options (based on susceptibility):

• TMP-SMZ
• Ampicillin
• Chloramphenicol
• Extended-spectrum cephalosporins 3

Duration of Therapy

• Mild gastroenteritis with CD4+ >200 cells/μL: 7-14 days 1
• Advanced HIV disease (CD4+ <200 cells/μL): 2-6 weeks 1
• Bacteremia or invasive disease: Minimum 14 days 1

Special Considerations

HIV-Infected Patients

• Long-term suppressive therapy (secondary prophylaxis) is required for those with Salmonella septicemia to prevent recurrence 1
• Ciprofloxacin is usually the drug of choice for susceptible organisms 1
• Evaluate household contacts for asymptomatic carriage to prevent recurrent transmission 1

Children

• Antiperistaltic drugs are not recommended for children 1
• Fluoroquinolones should be used with caution and only if no alternatives exist 1
• TMP-SMZ is the drug of choice for long-term therapy in children with Salmonella septicemia; ampicillin or chloramphenicol can be used if the organism is susceptible 1

Pregnant Women

• Avoid fluoroquinolones 1
• Preferred options: ampicillin, cefotaxime, ceftriaxone, or TMP-SMZ 1

Common Pitfalls and Caveats

1. Antibiotic resistance: Check local resistance patterns before finalizing therapy 3

2. Prolonged shedding: Antibiotics may prolong fecal shedding of Salmonella in immunocompetent hosts 4, 5

3. Monitoring: Follow patients closely for:

   • Response to treatment
   • Development of extraintestinal infections
   • Dehydration status
   • Nutritional status in prolonged illness 3

4. Follow-up: Repeat stool testing is not necessary in immunocompetent patients who recover clinically, but food handlers, healthcare workers, and childcare workers may need negative stool cultures before returning to work 3

5. Antimotility agents: Should be discontinued if symptoms persist beyond 48 hours or if high fever or bloody stools develop 1

The evidence clearly demonstrates that while antibiotics are necessary for high-risk populations and those with invasive disease, they offer no clinical benefit and may cause harm in otherwise healthy individuals with uncomplicated Salmonella gastroenteritis.