infectious diseases
Nontyphoidal Salmonella Infections
Treatment
Supportive care Antibiotics for high-risk patients and patients with systemic or focal infections Sometimes surgery infections is treated symptomatically with oral or IV fluids (see Treatment ). Antibiotics do not hasten resolution of gastroenteritis, may prolong excretion of the organism, and are unwarranted in uncomplicated cases. However, in older nursing home residents, infants, and patients with hemoglobinopathies, HIV infection, or other immunocompromising conditions, increased mortality dictates treatment with antibiotics. Acceptable antibiotic regimens include the following: TMP/SMX 5 mg/kg (of the TMP component) orally every 12 hours for children Ciprofloxacin500 mg orally every 12 hours for adults Azithromycin500 mg orally on day 1 followed by 250 mg once a day for 4 days for adults Ceftriaxone2 g IV once a day for 7 to 10 days for adults In uncomplicated nontyphoidalSalmonellagastroenteritis, antibiotics do not hasten resolution of symptoms, may prolong excretion of the organism, and are unwarranted. Nonimmunocompromised patients should be treated for 3 to 5 days; patients with AIDS may require prolonged suppression to prevent relapses. Systemic or focal disease should be treated with Treatment . Sustained bacteremia is generally treated for 4 to 6 weeks. Abscesses should be drained surgically. At least 4 weeks of antibiotic therapy should follow surgery. Infected aneurysms and heart valves and bone or joint infections usually require surgical intervention and prolonged courses of antibiotics. The prognosis is usually good, unless severe underlying disease is present. Case fatality rates resulting from endocarditis and endarteritis are high. Asymptomatic carriage is usually self-limited, and antibiotic treatment is rarely required. In unusual cases (eg, in food handlers or health care workers), eradication may be attempted with oralciprofloxacin500 mg every 12 hours for 1 month. Follow-up stool cultures should be obtained in the weeks after drug administration to document elimination ofSalmonella. 