What is the treatment for salmonella infection?

Treatment for Salmonella Infection

For most immunocompetent adults with uncomplicated Salmonella gastroenteritis, antibiotic treatment is not recommended as the infection is typically self-limiting and antibiotics may prolong bacterial shedding. 1, 2, 3

Treatment Approach Based on Patient Population

Immunocompetent Adults with Uncomplicated Gastroenteritis

• Fluid and electrolyte replacement is the cornerstone of therapy for uncomplicated Salmonella gastroenteritis 4
• Antibiotic therapy is generally not recommended for mild to moderate gastroenteritis in immunocompetent adults as it does not shorten illness duration and may increase the risk of relapse and prolonged fecal shedding 2, 3
• Studies show no significant differences in length of illness, diarrhea, or fever between antibiotic treatment and placebo in uncomplicated cases 3

Populations Requiring Antibiotic Treatment

Antibiotics are indicated for the following high-risk groups:

• HIV-infected persons/immunocompromised patients:

  • All HIV-infected persons with Salmonella gastroenteritis should receive antibiotic treatment due to high risk of bacteremia 1, 4
  • Treatment duration varies based on CD4 count:
    • CD4 >200 cells/μL: 7-14 days 1
    • CD4 <200 cells/μL: 2-6 weeks 1
  • Long-term suppressive therapy may be needed to prevent recurrence 1

• Infants and young children:

  • HIV-exposed infants <3 months and all HIV-infected children with severe immunosuppression should receive treatment 1, 4
  • Infants <3 months of age should receive treatment even if immunocompetent due to higher risk of bacteremia 2

• Pregnant women:

  • Should receive treatment due to risk of extraintestinal spread that could affect the placenta and amniotic fluid 1, 4

• Severe disease or bacteremia:

  • Patients with evidence of invasive disease or systemic symptoms require antibiotic therapy 1, 5

Antibiotic Selection

First-line Treatment Options

• Ciprofloxacin is the first-line treatment for adults requiring antibiotics:
  • Dosage: 500 mg twice daily for 7-14 days in immunocompetent adults 1, 6
  • FDA-approved for treatment of typhoid fever caused by Salmonella typhi 6
  • Was used successfully in outbreaks of Salmonella gastroenteritis at 500 mg twice daily for 7 days 7

Alternative Treatment Options

• Trimethoprim-sulfamethoxazole (TMP-SMX) if the organism is susceptible 1, 4
• Expanded-spectrum cephalosporins (e.g., ceftriaxone or cefotaxime) based on susceptibility testing 1, 4
• Ampicillin is FDA-approved for infections of the gastrointestinal tract caused by Salmonella 8
• Azithromycin may be considered for severe systemic infections 5

Special Population Considerations

• Children:

  • Fluoroquinolones should be used with caution in children under 18 years 1, 4
  • Preferred options include TMP-SMX, ampicillin, cefotaxime, or ceftriaxone 1, 4
  • Antimotility agents should not be given to children under 18 years 4

• Pregnant women:

  • Fluoroquinolones should be avoided 1, 4
  • Recommended alternatives include ampicillin, cefotaxime, ceftriaxone, or TMP-SMX 1, 4

• Severe infections/bacteremia:

  • Initial combination therapy with ceftriaxone (2 g once daily IV) plus ciprofloxacin until susceptibility results are available 1

Prevention Strategies

• Practice proper hand hygiene, especially after handling pets and before eating 1, 4
• Ensure proper food handling and avoid consuming raw or undercooked foods 1, 9
• Household contacts of HIV-infected persons with salmonellosis should be evaluated for asymptomatic carriage 10, 4
• Avoid contact with reptiles and poultry which can be reservoirs for Salmonella 1, 2

Important Considerations

• Antimicrobial resistance is increasing, particularly to fluoroquinolones and through production of extended-spectrum beta-lactamases 5
• Susceptibility testing should guide final antibiotic selection whenever possible 1, 4
• Relapses are more frequent in those receiving antibiotics, and there may be more cases with positive cultures after treatment 3