Salmonellosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Jolanta Marszalek, M.D. [3]
Overview
Medical Therapy
Treatment of salmonellosis is often symptomatic, with electrolyte replacement and rehydration. Mild cases of salmonelloses usually resolve within 5 to 7 days. Patients with severe cases of the disease may require rehydration, often with intravenous fluids. Antibiotic treatment is not routinely recommended, unless the patient becomes severely dehydrated or infection reaches the blood stream.[1]
Salmonellosis commonly presents with unspecific gastrointestinal symptoms, such as diarrhea, fever, and abdominal pain. Antibiotic treatment of infectious diarrhea is considered controversial because:[2]
- Symptoms may be caused by different types of enteric pathogens, which makes the initial treatment of severe cases often "empiric"
- Antibiotic treatment of non-typhoidal salmonellosis prolongs shedding of the bacteria in feces.
Supportive Treatment
Initial therapy of infectious diarrhea, irrespectively from the causative agent, should start with rehydration. Preferred oral rehydration is preferred, except in cases where the patient is severely dehydrated or comatose. [3]
Symptomatic Treatment
Antibiotic Treatment
Antibiotic therapy is indicated for patients with severe cases of the disease, and for those with risk factors of extra intestinal infection, after blood and fecal cultures have been obtained. Risk groups for the development of extra-intestinal manifestations include:[2][4]
- Infants and elderly
- Patients with pernicious anemia
- Patients taking H2 antagonists and antacids
- Changes in endogenous bowel flora, in:
- Surgery
- Recent antibiotic treatment
- Diabetes
- HIV infection
- Malignancy
- Rheumatological diseases
- Blockage of reticuloendothelial system
- Immunosuppressive therapy
Antibiotic treatment may be indicated in cases when rapid interruption of fecal shedding of the bacteria is required to avoid outbreaks in institutions.[5]
1st Line Antibiotics
2nd Line Antibiotics
Multidrug Resistance
Some serovars of Salmonella enterica, particularly Typhimurium and Newport, are linked to more severe cases of salmonellosis and multi-drug resistance.[4]
Follow Up
Fecal cultures are not indicated for patient follow-up after uncomplicated cases of salmonellosis, irrespectively to the treatment administrated. The results tend to be intermittently positive for a long period of time, and do not show any utility in an asymptomatic patient.[2][6]
References
- ↑ "Salmonella (non-typhoidal)".
- ↑ 2.0 2.1 2.2 Hohmann EL (2001). "Nontyphoidal salmonellosis". Clin Infect Dis. 32 (2): 263–9. doi:10.1086/318457. PMID 11170916.
- ↑ Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.
- ↑ 4.0 4.1 Gal-Mor O, Boyle EC, Grassl GA (2014). "Same species, different diseases: how and why typhoidal and non-typhoidal Salmonella enterica serovars differ". Front Microbiol. 5: 391. doi:10.3389/fmicb.2014.00391. PMID 25136336.
- ↑ Lightfoot NF, Ahmad F, Cowden J (1990). "Management of institutional outbreaks of Salmonella gastroenteritis". J Antimicrob Chemother. 26 Suppl F: 37–46. PMID 2292544.
- ↑ Buchwald DS, Blaser MJ (1984). "A review of human salmonellosis: II. Duration of excretion following infection with nontyphi Salmonella". Rev Infect Dis. 6 (3): 345–56. PMID 6377442.