What is the treatment for Salmonella infection of the skin?

Treatment of Salmonella Infection of the Skin

For Salmonella skin infections, fluoroquinolones such as ciprofloxacin are the first-line treatment, with a recommended dosage of 750 mg twice daily for 14 days. 1

General Treatment Approach

• Skin infections caused by Salmonella are rare but can occur as a complication of Salmonella septicemia, particularly in immunocompromised patients 2
• Treatment should be initiated promptly to prevent complications and extraintestinal spread 1
• The choice of antibiotics depends on:
  • Patient population (adult, child, pregnant woman)
  • Severity of infection
  • Immune status of the patient 1

First-Line Treatment Options for Adults

• Fluoroquinolones are the preferred first-line agents for Salmonella infections in adults 1
  • Ciprofloxacin 750 mg twice daily for 14 days is the recommended regimen 1
  • Other fluoroquinolones (levofloxacin, moxifloxacin) may also be effective but are less well-studied 1
• For patients with advanced immunosuppression (CD4+ count <200 cells/μL in HIV patients), a longer course of antibiotics (2-6 weeks) is often recommended 1

Alternative Treatment Options for Adults

• Trimethoprim-sulfamethoxazole (TMP-SMZ) can be used if the organism is susceptible 1
• Expanded-spectrum cephalosporins (ceftriaxone, cefotaxime) are alternatives based on susceptibility testing 1
• Azithromycin may be considered, particularly when resistance to other agents is a concern 3

Treatment in Special Populations

Children

• For children, the recommended antibiotics include:
  • TMP-SMZ (drug of choice) 1
  • Ampicillin 1
  • Cefotaxime 1
  • Ceftriaxone 1
  • Chloramphenicol 1
• Fluoroquinolones should be used with caution in children and only if no alternatives exist 1

Pregnant Women

• Fluoroquinolones should be avoided during pregnancy 1
• Recommended alternatives include:
  • Ampicillin 1
  • Cefotaxime 1
  • Ceftriaxone 1
  • TMP-SMZ 1

Prevention of Recurrence

• For patients who have had Salmonella septicemia, long-term therapy (secondary prophylaxis) is required to prevent recurrence 1
• For adults, fluoroquinolones (primarily ciprofloxacin) are usually the drugs of choice for susceptible organisms 1
• For children, TMP-SMZ is the drug of choice; ampicillin or chloramphenicol can be used if the organism is susceptible 1

Treatment Duration

• For localized skin infections without bacteremia in immunocompetent patients: 7-14 days 1
• For patients with advanced immunosuppression: 2-6 weeks 1
• For patients with Salmonella septicemia: long-term therapy may be required 1

Important Considerations and Caveats

• Antimicrobial resistance is an increasing concern with Salmonella infections 4
• Susceptibility testing should guide therapy whenever possible 4
• The emergence of multidrug-resistant Salmonella strains, including those producing extended-spectrum beta-lactamases, may complicate treatment 4
• For mild to moderate gastroenteritis caused by non-typhoidal Salmonella in immunocompetent adults or children over 1 year of age, antibiotic treatment is generally not recommended as it may prolong the carrier state 5, 6
• However, for skin infections, which represent extraintestinal spread, antibiotic therapy is necessary 2

Monitoring and Follow-up

• Monitor for clinical improvement within 48-72 hours of initiating therapy
• If no improvement is observed, consider:
  • Alternative antibiotics based on susceptibility testing
  • Possible abscess formation requiring drainage
  • Evaluation for underlying immunodeficiency 1