What is the treatment for Salmonella infections?

Treatment for Salmonella Infections

The first-line treatment for Salmonella infections is ciprofloxacin, typically administered at 500 mg twice daily for 7-14 days in immunocompetent adults with mild to moderate infections. 1

General Treatment Approach

• Most uncomplicated Salmonella gastroenteritis in immunocompetent individuals is self-limiting and does not require antibiotic therapy 2, 3
• Fluid and electrolyte replacement is the cornerstone of therapy for all patients with Salmonella gastroenteritis 4
• Antimotility agents (e.g., loperamide) should be avoided in patients with high fever or blood in stool 5

Populations Requiring Antibiotic Treatment

Immunocompromised Patients

• HIV-infected persons should always receive antimicrobial therapy for Salmonella gastroenteritis to prevent extraintestinal spread 1, 4
• Treatment duration varies based on immune status:
  • CD4+ count >200 cells/μL: 7-14 days 1, 4
  • CD4+ count <200 cells/μL: 2-6 weeks 1, 4
• HIV-infected patients with Salmonella septicemia require long-term suppressive therapy to prevent recurrence 5

Children

• HIV-exposed infants <3 months of age and all HIV-infected children with severe immunosuppression should receive treatment 5, 4
• Preferred antibiotics for children include:
  • TMP-SMZ, ampicillin, cefotaxime, or ceftriaxone 5
  • Fluoroquinolones should be used with caution and only if no alternatives exist 5, 1

Pregnant Women

• Pregnant women with Salmonella gastroenteritis should receive treatment due to risk of extraintestinal spread affecting the placenta and amniotic fluid 5, 4
• Recommended antibiotics during pregnancy:
  • Ampicillin, cefotaxime, ceftriaxone, or TMP-SMZ 5, 4
  • Fluoroquinolones should be avoided during pregnancy 5, 4

Antibiotic Selection

First-Line Options

• Ciprofloxacin is the preferred fluoroquinolone for adults, typically at 500 mg twice daily 1, 6
• For severe infections or in immunocompromised patients, initial combination therapy with ceftriaxone (2 g once daily IV) plus ciprofloxacin is recommended until susceptibility results are available 1

Alternative Options

• Trimethoprim-sulfamethoxazole (TMP-SMZ) if the organism is susceptible 1, 4
• Expanded-spectrum cephalosporins (e.g., ceftriaxone or cefotaxime) 1, 4
• Ampicillin for susceptible strains 7
• Azithromycin has shown efficacy with less resistance development 8

Treatment Duration

• Immunocompetent adults with mild gastroenteritis: 7-14 days 1
• Immunocompromised patients with advanced disease: 2-6 weeks 1, 4
• Bacteremia in any patient: minimum 14 days 1

Prevention Strategies

• Practice proper hand hygiene, especially after handling pets and before eating 1, 4
• Household contacts of HIV-infected persons with salmonellosis should be evaluated for asymptomatic carriage 5
• Avoid contact with reptiles and poultry 1
• Ensure proper food handling and avoid consuming raw or undercooked foods 4

Important Considerations

• Antibiotic resistance is increasing, particularly to fluoroquinolones and through extended-spectrum beta-lactamase production 2, 9
• Susceptibility testing should guide final antibiotic selection whenever possible 1, 4
• Recent research suggests azithromycin may be safer than other options in terms of side effects and relapse rates 8