What is the treatment for Salmonella infections in hospitalized elderly patients with potential complications such as dehydration, hypotension, and impaired renal function?

From the Guidelines

Treatment of hospitalized elderly patients with salmonella infection typically involves intravenous antibiotics, fluid replacement, and close monitoring, with fluoroquinolones like ciprofloxacin or third-generation cephalosporins such as ceftriaxone being first-line treatments, as recommended by the most recent guidelines 1. The choice of antibiotic should be guided by local susceptibility patterns and the severity of the infection.

• For severe salmonella infections in the elderly, fluoroquinolones like ciprofloxacin (400mg IV twice daily) or levofloxacin (500mg IV daily) are first-line treatments, usually administered for 7-14 days depending on infection severity.
• Third-generation cephalosporins such as ceftriaxone (1-2g IV daily) may be used as alternatives, especially if antibiotic resistance is suspected.
• Fluid and electrolyte replacement is crucial as elderly patients are more susceptible to dehydration from diarrhea.
• Monitoring for complications is essential, as the elderly have higher risks of bacteremia, metastatic infections, and cardiovascular complications.
• Treatment should be adjusted based on culture and sensitivity results, which typically become available 48-72 hours after admission, as suggested by previous studies 1. Key considerations in the management of salmonella infections in the elderly include:
• The potential for antibiotic resistance, which may require the use of alternative antibiotics.
• The risk of complications, such as bacteremia and metastatic infections, which may require more aggressive treatment.
• The importance of fluid and electrolyte replacement to prevent dehydration.
• The need for close monitoring and adjustment of treatment based on culture and sensitivity results. In general, the management of salmonella infections in the elderly should be guided by the principles of minimizing morbidity, mortality, and improving quality of life, as outlined in the most recent guidelines 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment Options for Salmonella Infections

• Quinolone antibiotics, such as norfloxacin and ciprofloxacin, have been shown to be effective in treating Salmonella infections, including chronic carriage of S. typhi and other salmonellae 2, 3.
• Third-generation cephalosporins, such as ceftriaxone, have also been found to be effective in treating Salmonella infections, including multidrug-resistant strains 4.
• A systematic review found that azithromycin and ceftriaxone were more effective in treating Salmonella infections than other drugs, including ciprofloxacin and amoxicillin 5.
• Fluoroquinolones, such as ciprofloxacin, are effective in treating Salmonella infections but are not approved for use in children 5.

Considerations for Hospitalized Elderly Patients

• The risk of hospitalization due to Salmonella infection increases with age, with elderly males having the highest risk of infection-related hospitalization 6.
• Hospitalized elderly patients with Salmonella infections may require careful consideration of treatment options, including the use of quinolone antibiotics or third-generation cephalosporins.
• The choice of treatment should be based on the severity of the infection, the patient's underlying health status, and the potential for antibiotic resistance 5, 4.