Salmonella choice

The drug of choice for chronic carriers of Salmonella is norfloxacin, 400 mg orally twice daily for 28 days. 

If presumptive therapy is initiated, perform in vitro sensitivity tests concurrently, so that the drug may be discontinued if less potentially dangerous agents are indicated. Acute infections In acute infections caused by Salmonella typhi, chloramphenicol is a drug of choice. 

Typhoid fever caused by Salmonella typhi or S. paratyphi is an important and prevalent cause of continuous fever without localizing symptoms in the tropics. The diagnosis can be confirmed with a bloodculture. Response on therapy is often seen only after 3 days when the fever subsides. Chloramphenicol-resistant Salmonella typhi was first described in Vietnam in 1973. Its prevalence reached 95% in the 1970s and then decreased to 54% in the 1980s after cotrimoxazole became the treatment of choice. In the mid-1993, there was a dramatic increase in the number of strains of S. typhi, isolated in the hospital and from patients in the outbreaks, which are resistant to the three first-line antibiotics chloramphenicol, cotrimoxazol and ampicillin. This indicated that there was an urgent need for effective antibiotics for the treatment of typhoid fever. 

Chloramphenicol remains a major treatment of typhoid and paratyphoid fever in developing countries. However, with increasing resistance to ampicillin, trimethoprim-sulfamethoxazole and, to some extent, chloramphenicol, fluoroquinolones and some third-generation cephalosporins (e.g., ceftriaxone) have become the drugs of choice. Salmonella infections, such as osteomyelitis, meningitis and septicemia, have also been indications for chloramphenicol use. Nevertheless, antibiotic resistance patterns can be a problem. As noted previously, nonty-phoidal salmonella enteritis is not benefited by treatment with chloramphenicol or other antibiotics. 

Ciprofloxacin is approved for use in the treatment of bone and joint infections, infectious diarrhea caused by Shigella or Campylobacter, lower respiratory tract infections, skin infections, and urinary tract infections. It is the drug of choice for the treatment of infections caused by Campylobacter jejuni. In addition, it has found off-label use as an alternative drug for the treatment of gonorrhea, salmonella, and yersinia... 

Salmonella. An antimicrobial should be used for severe salmonella gastroenteritis, or for bacteraemia or salmonella enteritis in an immunocompromised patient. The choice lies between ciprofloxacin, amoxicillin or co-trimoxazole, according to the sensitivity of the pathogen. 

The presence/absence procedure was based on the ISO method for the detection of Salmonella (ISO 6579) which is summarised as follows (1) pre-enrichment in Buffered Peptone water (incubation time (18 2) h at (37 1)°C) and (2) selective enrichment in broth of own choice (incubation time and temperature according to own procedure). The detailed procedure is described elsewhere [37]. Each laboratory determined the presence or absence of Salmonella in 50 capsules. Four of these individually identified capsules were negative control capsules. The numbers of these capsules were unknown to the laboratories at the time of analysis. For the presence/absence procedure, all capsules showing typical colonies on the isolation agar were subjected to a confirmation for Salmonella. At least two colonies per capsule were used for this confirmation. All colonies (>1000 colonies) tested by the laboratories gave a positive Salmonella identification. The type of confirmation test used is described elsewhere [37]. 

Osteomyelitis in apatient with a hemoglobinopathy, such as sickle cell anemia, is commonly caused by either Salmonella or S. aureus. Thus empirical antibiotics of first choice are ceftriaxone or cefotaxime. Alternatives are chloramphenicol and ciprofloxacin (in adults). 

ELISAs can be used in two modes, qualitatively to determine the presence or absence, or quantitatively to determine the amount of antigen present. ELISA kits often depend on the adsorption of either the antibody or antigen to a solid phase, e.g., wells of a microtiter plate, surface of plastic beads, or plastic stick. The choice of antibody (or antibodies) used determines the specificity of the ELISA assay, which can range from genus-specific to strain-specific. The principle on which ELISA methods are based usually prevents them from being used for the determination of total microbial counts. However, they can be used to detect pathogens such as Salmonella spp.. Listeria spp. 

Chloramphenicol - Chloramphenicol Is considered the drug of choice for treatment of typhoid fever, but recently R-factor mediated resistant strains of Salmonella typht have appeared in epidemics In Mexlcol53 los Angelesl54 and Viet Nam.155 in staphylococci, chloramphenicol resistance has been shown to be caused by acetyltransferases of 4 distinct types, each existing as a tetramerlc protein with a molecular weight of 80,000 and an Identical subunit size of 20,400,156... 

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