Non Typhoid Salmonella Infection: Treatment

Treatment of non typhoid Salmonella infection is different from typhoid infection due to Salmonella Typhi. In the treatment of non typhoid Salmonella infection antibiotic should not be used routinely as used in typhoid. Antibiotics should only be used if required, as most of the infections of non typhoid Salmonella are self limiting type and the duration of diarrhea and fever are not much affected by use of antibiotics. Additionally antibiotic therapy can increase relapse of the infection and also prolong the duration of gastrointestinal carrier state.

The main treatment should be aimed at correcting dehydration that may arise due to prolonged diarrhea, by fluid and electrolyte replacement.

Preemptive antibiotic treatment is required in case of neonates (up to 3 months of age), persons with age of more than 50 years with suspected atherosclerosis, patients with immunosuppression, cardiac valvular disease, endovascular abnormalities, significant joint disease etc. The preemptive treatment of non typhoid Salmonella infection should be done by oral or intra venous (IV) administration of antibiotics (Ciprofloxacin 500 mg twice a day; Trimethoprim-sulfamethoxazole 160/800 mg twice a day; Ceftriaxone 2000 mg/day; Amoxicillin 100 mg three times a day or Ampicillin 2000 mg every 4 hourly) for 2 to 3 days (48 to 72 hours) or till fever subsides. If patient is immunocompromised treatment may have to be continued for 1 to 2 weeks. Due to high incidences of antibiotic resistance, a third generation cephalosporin (Ceftriaxone) antibiotic or a fluoroquinolone (Ciprofloxacin) should be included in the empirical therapy for life-threatening NTS bacteremia or focal NTS infection. If a patient is suffering from non typhoid Salmonella infection with bacteremia (bacteria in blood) and AIDS, he/she should be treated for 1 to 2 weeks of intravenous antibiotics and followed by 4 weeks of treatment with oral Ciprofloxacin. If there is relapse of the infection, after the therapy (in AIDS patients) than the patient should be given long term suppressive therapy with a fluoroquinolone or trimethoprim-sulfamethoxazole (after doing culture and sensitivity test).

If patient has endocarditis or arteritis the treatment is by intravenous beta-lactum antibiotics like ceftriaxone or ampicillin. Surgical intervention is recommended where required.

For extraintestinal nonvascular non typhoid Salmonella infections, a 2 to 4 weeks course of antibiotic therapy (depending on the infection site) is recommended. In case of chronic osteomyelitis, abscess, urinary infection or hepatobiliary (liver and gall bladder) infection associated with anatomic abnormalities, surgical resection or drainage may be required in addition to prolonged antibiotic therapy for eradication of infection.    

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