From the Guidelines
For a 22kg child with salmonella infection, the recommended trimethoprim-sulfamethoxazole (TMP-SMX) dosage is 8-12mg/kg/day of the trimethoprim component, divided into two doses, as indicated by the most recent and highest quality study available 1. This translates to approximately 176-264mg of trimethoprim per day, or 88-132mg of trimethoprim twice daily. Using the standard pediatric suspension (40mg TMP/200mg SMX per 5mL), this would be about 22-33mL twice daily. Some key points to consider when treating a child with salmonella infection include:
- Ensuring adequate hydration during treatment, as salmonella infections often cause diarrhea
- Monitoring for side effects including rash, gastrointestinal disturbances, and rarely blood dyscrasias
- Considering alternative antibiotics if the child has a sulfa allergy, based on susceptibility testing
- Reserving antibiotic treatment for severe infections, invasive disease, or high-risk patients, as uncomplicated gastroenteritis often resolves without antibiotics The typical treatment duration is 5-7 days, but this may vary depending on the severity of the infection and the child's response to treatment. It's also important to note that TMP-SMX works by inhibiting bacterial folate synthesis at two different points, making it effective against many enteric pathogens including salmonella, as supported by studies such as 1 and 1.
From the FDA Drug Label
Children: The recommended dose for children with urinary tract infections or acute otitis media is 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours for 10 days. An identical daily dosage is used for 5 days in the treatment of shigellosis The following table is a guideline for the attainment of this dosage: Children 2 months of age or older: Weight Dose - every 12 hours lb kg Teaspoonfuls 22 10 1 (5 mL) 44 20 2 (10 mL) 66 30 3 (15 mL) 88 40 4 (20 mL)
The recommended daily dose of trimethoprim-sulfamethoxazole (TMP-SMX) for the treatment of salmonellosis in a child weighing 22 kilograms is 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours. Using the guideline table, for a child weighing 22 kg, the dose is 1 teaspoonful (5 mL) every 12 hours 2.
From the Research
Recommended Daily Dose of Trimethoprim-Sulfamethoxazole (TMP-SMX)
- The recommended daily dose of TMP-SMX for the treatment of salmonellosis is not explicitly stated in the provided studies for a child weighing 22 kilograms.
- However, a study from 1975 3 mentions that patients were treated with TMP-SMX as the sole medication, but it does not provide a specific dosage for children.
- Another study from 1995 4 mentions the use of TMP-SMX in children, but it does not provide a recommended daily dose.
- A study from 1977 5 mentions the use of TMP-SMX for the management of Salmonella typhi and paratyphi carriers, with a daily dose of 2 X 2 tablets of sulprim (TMP-SMX) for 12 weeks, but it does not provide a specific dosage for children weighing 22 kilograms.
Considerations for Treatment
- The choice of antibiotics for the management of salmonellosis should be guided by the local resistance pattern, as mentioned in a study from 2015 6.
- The use of TMP-SMX in children is limited by its side-effects, as mentioned in a study from 1995 4.
- The treatment of salmonellosis with antibiotics is not recommended for mild to moderate gastroenteritis in immunocompetent adults or children over 1 year of age, as mentioned in a study from 2015 6.