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Salmonella (cont.)

Treatment of Salmonella Infection

Patient Comments

Treatment for salmonellosis is controversial. Since the disease is often self-limited and some studies show no difference in outcomes between antibiotic-treated and untreated patient populations, many doctors recommend no antibiotics and cite evidence that antibiotics may prolong a carrier state. Other physicians disagree and treat with antibiotics for up to 10-14 days. Most physicians will treat patients with antibiotics if the patients are immunosuppressed (for example, patients that have AIDS, cancer, or the elderly). Usually, the antibiotics (fluoroquinolones or cephalosporins) are given orally for a few days until the fever stops. If Salmonella are isolated from the patient, the bacteria should be studied to determine if they are resistant to certain antibiotics so the physician can choose the most effective treatment. This needs to be done especially for patients with typhoid and paratyphoid fever because all these patients should be treated with antibiotics that are effective against these Salmonella spp.

Just like the problems seen with MRSA worldwide, multi-drug resistant S. spp serovars are being reported. Resistance to fluoroquinolone antibiotics has been reported to be as high as 41% in some S. typhi serovars. The use of an effective antibiotic is important since antibiotic therapy for typhoid and paratyphoid may be lengthy (five to seven days for uncomplicated cases, 10-14 days for severe infections, four to six weeks for septic and focal infections, and one to three months in S. spp carriers). Occasionally, surgery is required to treat a site of focal infection. For example, the infected gallbladder is removed in some patients who are carriers.

Complications of Salmonella Infection

The majority of patients with salmonellosis have no complications. However, patients who are immune compromised may develop complications similar to those for typhoid fever. Complications that may occur with typhoid fever (and less frequently for paratyphoid fever) are numerous and occur in about 30% of untreated or undertreated infections. Patients may exhibit one or more complications, with a low mortality rate (death). The following is a partial list of some of the most serious complications of typhoid fever: meningitis, psychosis, hydrocephalus, sepsis, intestinal perforation, myocarditis, abscesses, aortic aneurysm, nephritis, osteomyelitis (especially in patients with sickle cell disease), and a persistent carrier state. There are many other problems that can occur with most organ systems in the body. Early diagnosis and appropriate antibiotic therapy greatly reduce the complication rate.

Medically Reviewed by a Doctor on 5/25/2016

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