Treatment: Salmonellosis

• Typhoid fever: A fluoroquinolone (e.g., ciprofloxacin, 500 mg PO bid for 5-7 days) is most effective against susceptible organisms.
  • - Pts infected with nalidixic acid-resistant strains (whose susceptibility to ciprofloxacin is reduced) should be treated with ceftriaxone (2 g/d IV for 10-14 days), azithromycin (1 g/d PO for 5 days), or high-dose ciprofloxacin (750 mg PO bid or 400 mg IV q8h for 10-14 days).
  • - Dexamethasone may be of benefit in severe cases.
• NTS: Antibiotic treatment is not recommended in most cases as it does not shorten the duration of symptoms and is associated with increased rates of relapse, a prolonged carrier state, and adverse drug reactions.
  • - Antibiotic treatment may be required for infants ≤3 months of age; pts >50 years of age with suspected atherosclerosis; pts with immunosuppression; pts with cardiac, valvular, or endovascular abnormalities; and pts with significant joint disease.
  • - Fluoroquinolones or third-generation cephalosporins are given for 3-7 days or until defervescence (if the pt is immunocompetent) or for 1-2 weeks (if the pt is immunocompromised).
  • - HIV-infected pts are at high risk for Salmonella bacteremia and should receive 4 weeks of oral fluoroquinolone therapy after 1-2 weeks of IV treatment. In cases of relapse, long-term suppression with a fluoroquinolone or TMP-SMX should be considered.
  • - Pts with endovascular infections or endocarditis should receive 6 weeks of treatment with a third-generation cephalosporin.