From the Guidelines
Antimotility agents should be avoided in the treatment of salmonella enteritis, as they can prolong the duration of fever and diarrhea, increase the risk of bacteremia, and potentially worsen the infection. According to the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1, antimotility drugs, such as loperamide, should not be given to children <18 years of age with acute diarrhea, and their use should be avoided in suspected or proven cases where toxic megacolon may result in inflammatory diarrhea or diarrhea with fever.
The treatment of salmonella enteritis should focus on maintaining adequate hydration with oral rehydration solutions or, in severe cases, intravenous fluids. Antibiotics are typically reserved for high-risk patients, such as infants, elderly, immunocompromised individuals, or those with severe disease, with ciprofloxacin 500 mg twice daily for 5-7 days or azithromycin 500 mg once daily for 3-5 days being common regimens, as recommended by the guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents 2.
Some key points to consider in the treatment of salmonella enteritis include:
- Maintaining adequate hydration to prevent dehydration and electrolyte imbalances
- Avoiding antimotility agents, which can worsen the infection
- Reserving antibiotics for high-risk patients or those with severe disease
- Using ciprofloxacin or azithromycin as first-line antibiotic therapy, as recommended by the guidelines 2
- Considering alternative treatments, such as TMP-SMX or expanded spectrum cephalosporins, depending on antibiotic susceptibility, as recommended by the guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents 2.
It is essential to note that the use of antimotility agents in salmonella enteritis can have severe consequences, including increased risk of bacteremia and worsening of the infection, as highlighted in the practice guidelines for the management of infectious diarrhea 3. Therefore, the use of antimotility agents should be avoided in the treatment of salmonella enteritis, and treatment should focus on maintaining adequate hydration, reserving antibiotics for high-risk patients, and using recommended antibiotic regimens.
From the FDA Drug Label
patients with bacterial enterocolitis caused by invasive organisms including Salmonella, Shigella, and Campylobacter. Loperamide is contraindicated in patients with bacterial enterocolitis caused by invasive organisms, including Salmonella.
- Do not use loperamide to treat salmonella enteritis. 4
From the Research
Treatment of Salmonella Enteritis with Antimotility Agents
- There is no direct evidence to support the use of antimotility agents in the treatment of salmonella enteritis 5, 6, 7, 8, 9.
- The use of antibiotics in treating salmonella infections has been shown to have no significant clinical benefit in otherwise healthy children and adults with non-severe salmonella diarrhea, and may even increase adverse effects and prolong salmonella detection in stools 5.
- Some studies suggest that antimicrobial production can be enhanced through interactions between Lactobacillus species and Salmonella enterica serovar Typhimurium, which could potentially be used as a natural food processing and preservation strategy to control Salmonella food contaminations 9.
- The treatment of salmonella enteritis should focus on managing symptoms and preventing complications, rather than relying on antimotility agents or antibiotics 7, 8.
Alternative Treatment Approaches
- The use of probiotics, such as Lactobacillus species, may be a potential alternative to antibiotics in the treatment of gut-associated diseases, including salmonella enteritis 9.
- Further research is needed to investigate the efficacy and safety of probiotics in the treatment of salmonella enteritis, as well as their potential to enhance antimicrobial production and control Salmonella food contaminations 9.
- The development of innovative approaches to mitigate antimicrobial resistant infections, such as the use of quinolones, should be carefully considered and restricted to specific cases, such as early empirical treatment of severely ill and vulnerable patients 8.