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[Acute enteritis caused by Salmonella: effect of mecillinam and cotrimoxazole on the clinical course and fecal carrier state].

In a prospective randomized study we have evaluated the influence of co-trimoxazole and mecillinam on the clinical outcome and the fecal Salmonella sp carrier status in 134 adult patients with acute non-typhi Salmonella sp enteritis. The patients were distributed in three groups on the basis of predefined clinical and biological criteria, depending on their risk of bacteremia or severe complications of it, or on the enteroinvasive character of the causative organism. The inclusion in any group determined the treatment. Seventy-six patients received mecillinam (1.200 mg/day p.o.), 36 co-trimoxazole (1.600 mg/day p.o.), both during five days, and 22 only diet. The patients were investigated after 1, 3 and 6 weeks until stool culture was negative. The isolated Salmonella strains, either in stool or blood culture, had a sensitivity of 98.3% to mecillinam and 96.9% to cotrimoxazole. Resistance did not develop during therapy. All patients had a favorable outcome, including the six with bacteremia. No differences were found regarding clinical features (diarrhea, abdominal pain, fever) or the rate of positive stool cultures in the three therapeutic groups in any of the follow-up controls. It was concluded that the administration of mecillinam or co-trimoxazole to patients with Salmonella sp enteritis is not associated with a prolongation of the state of fecal carrier or with the development of resistant strains.