What is the treatment for Salmonella (salmonellosis) enteritis?

From the Guidelines

Salmonella enteritis is typically treated with supportive care while the infection runs its course, and antibiotics are generally reserved for severe cases, high-risk patients, or invasive infections. Most cases resolve without antibiotics in 4-7 days. Focus on staying hydrated by drinking plenty of clear fluids like water, diluted fruit juices, or oral rehydration solutions (such as Pedialyte) 1. Take acetaminophen (Tylenol) for fever and discomfort at recommended doses (650-1000mg every 6 hours for adults, not exceeding 4000mg daily). Avoid anti-diarrheal medications like loperamide (Imodium) as they can prolong the infection by keeping bacteria in your system.

When prescribed, common antibiotics include ciprofloxacin (500mg twice daily for 5-7 days), azithromycin (500mg daily for 3-5 days), or trimethoprim-sulfamethoxazole (160/800mg twice daily for 5-7 days) 2. However, the use of antibiotics should be guided by the severity of the infection and the patient's risk factors, as antibiotics can prolong the carrier state and lead to a higher clinical relapse rate 3.

Some key points to consider in the treatment of salmonella enteritis include:

• Practice strict hand hygiene and avoid preparing food for others until symptoms resolve and you've been symptom-free for at least 48 hours.
• The infection spreads through the fecal-oral route, so these measures prevent transmission while your body clears the bacteria naturally.
• Invasive disease, empirical treatment should be considered (after a fecal specimen is obtained for the performance of the studies noted above) 4.
• The choice of antimicrobial agent may change due to evolving resistance patterns 1.

Overall, the treatment of salmonella enteritis should be guided by the principles of supportive care, judicious use of antibiotics, and prevention of transmission.

From the FDA Drug Label

Infectious Diarrhea caused by Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, Shigella boydii†, Shigella dysenteriae, Shigella flexneri or Shigella sonnei† when antibacterial therapy is indicated. Typhoid Fever (Enteric Fever) caused by Salmonella typhi.

The treatment for salmonella enteritis is not explicitly stated, but Typhoid Fever (Enteric Fever) caused by Salmonella typhi is mentioned as an indication for ciprofloxacin. However, it is not clear if this applies to salmonella enteritis.

• The FDA label does mention Infectious Diarrhea caused by various strains, but it does not directly address salmonella enteritis.
• Therefore, based on the provided information, ciprofloxacin may be considered for the treatment of salmonella enteritis, but with caution and careful consideration of the specific patient and infection characteristics 5.

From the Research

Treatment Options for Salmonella Enteritis

• Oral rehydration therapy is the mainstay of treatment for mild dehydration and is as effective as intravenous rehydration for preventing hospitalization and return to the emergency department 6, 7.
• Oral rehydration solutions are recommended for moderate dehydration 6.
• Ondansetron may be prescribed if needed to prevent vomiting and improve tolerance of oral rehydration solutions 6, 8.
• Hospitalization and intravenous fluids are recommended for children who do not respond to oral rehydration therapy plus an antiemetic and patients with severe dehydration (i.e., signs of shock or more than 10% dehydration) 6, 9.

Comparison of Oral and Intravenous Rehydration

• Oral rehydration is an effective and inexpensive treatment, but some physicians prefer intravenous methods 10.
• There were more treatment failures with oral rehydration therapy (RD 4%, 95% confidence interval (CI) 1 to 7, random-effects model) 10.
• Shorter hospital stays were reported for the oral rehydration therapy group (WMD -1.20 days, 95% CI -2.38 to -0.02 days) 10, 8.

Use of Anti-emetics and Probiotics

• Oral ondansetron had lower hospital admission rates to the emergency department and lower rates of IV rehydration during their ED stay compared with children receiving placebo 8.
• Probiotic use amongst children hospitalized following acute gastroenteritis reduced the mean duration of hospitalization by 1.12 days (CI -1.16, -0.38) 8.

Rapid Intravenous Rehydration

• The efficacy and safety of rapid intravenous rehydration guidelines in children affected by dehydration secondary to acute gastroenteritis is supported by current scientific evidence 9.
• Isotonic fluids are recommended, suggesting saline fluid as the first option, supplemented by glucose (2.5%) in those patients showing normoglycemia and ketosis 9.
• A rhythm of 20 cc/kg/h is recommended during 1-4 h 9.