What is the treatment for symptoms of Salmonella infection, such as diarrhea, abdominal cramps, fever, and vomiting?

Treatment of Salmonella Infection Symptoms

The primary treatment for Salmonella infection symptoms is supportive care with fluid and electrolyte replacement, while antibiotics are generally not recommended for uncomplicated cases in immunocompetent individuals. 1, 2

Fluid and Electrolyte Management

• Oral rehydration solution (ORS) should be administered until clinical dehydration is corrected, followed by maintenance fluids to replace ongoing losses 1
• Intravenous fluids may be necessary for patients with severe dehydration or those unable to tolerate oral intake 1
• All patients with Salmonella infection should be evaluated for dehydration, which increases the risk of life-threatening illness and death, especially among young children and older adults 1

Symptomatic Management

• Antimotility drugs (e.g., loperamide) should NOT be given to children <18 years of age with acute diarrhea 1
• Loperamide may be given to immunocompetent adults with acute watery diarrhea but should be avoided in cases of inflammatory diarrhea or diarrhea with fever, which is common with Salmonella infection 1
• Antinausea and antiemetic medications (e.g., ondansetron) may be given to facilitate oral rehydration tolerance in children >4 years of age and adolescents with vomiting 1
• Probiotic preparations may be offered to reduce symptom severity and duration in immunocompetent adults and children 1

Antibiotic Therapy

• Antibiotics are NOT recommended for mild to moderate gastroenteritis caused by non-typhoidal Salmonella in immunocompetent adults or children >1 year of age 3, 2

• Antibiotic treatment may actually:

  • Prolong the duration of Salmonella shedding in stool 2, 4
  • Increase the risk of relapse 4
  • Lead to more adverse drug reactions 2
  • Contribute to antibiotic resistance 5

• Antibiotics SHOULD be considered in specific high-risk situations:

  • Infants <3 months of age due to higher risk of bacteremia 3
  • Immunocompromised patients 3
  • Patients with signs of invasive disease or sepsis 1
  • Patients with enteric (typhoid) fever 3
  • Patients with severe disease or risk factors for complications 1

When Antibiotics Are Indicated

• For adults requiring antibiotics, fluoroquinolones (e.g., ciprofloxacin) or azithromycin are typically recommended based on local resistance patterns 6, 5
• For children requiring antibiotics, options include third-generation cephalosporins, azithromycin, or trimethoprim-sulfamethoxazole (TMP-SMZ) 1, 5
• Azithromycin has been shown to be physicians' preferred choice due to less resistance development and better safety profile 5

Prevention of Transmission

• Hand hygiene should be performed after using the toilet, changing diapers, before and after preparing food, and before eating 1
• Appropriate food safety practices should be followed to avoid cross-contamination 1
• Ill people with diarrhea should avoid swimming, water-related activities, and sexual contact with others while symptomatic 1

Special Considerations

• Monitor for extra-intestinal manifestations of Salmonella infection, which may include endocarditis, pericarditis, vascular infections, and osteomyelitis, particularly in elderly patients with prolonged fever or bacteremia 7
• Follow-up testing is not recommended in most people following resolution of diarrhea, but may be required in certain situations by local health authorities 1
• Patients who do not respond to initial management should be reassessed for possible complications or alternative diagnoses 1

Common Pitfalls to Avoid

• Prescribing antibiotics for uncomplicated Salmonella gastroenteritis in immunocompetent hosts, which can lead to prolonged carriage and increased risk of relapse 2, 4
• Using antimotility agents in children or in adults with inflammatory diarrhea, which can mask worsening symptoms and potentially lead to serious complications 1
• Failing to adequately rehydrate patients, which is the cornerstone of management 1
• Not considering Salmonella infection in patients with fever and abdominal pain, especially those with relevant travel or exposure history 1