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Treatment of Salmonella Infection
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.
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