Salmonella infection treatment

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. 

A combination of trimethoprim-sulfamethoxazole is effective treatment for a wide variety of infections including P jiroveci pneumonia, shigellosis, systemic salmonella infections, urinary tract infections, prostatitis, and some nontuberculous mycobacterial infections. It is active against most Staphylococcus aureus strains, both methicillin-susceptible and methicillin-resistant, and against respiratory tract pathogens such as the pneumococcus, Haemophilus sp, Moraxella catarrhalis, and Klebsiella pneumoniae (but not Mycoplasma pneumoniae). However, the increasing prevalence of strains of E coli (up to 30% or more) and pneumococci that are resistant to trimethoprim-sulfamethoxazole must be considered before using this combination for empirical therapy of upper urinary tract infections or pneumonia. 

Furazolidone has been used for treatment of Salmonella infections in most farm animals. It has been also used as a feed additive for growth-promoting purposes. For poultry it was given in the feed at a level of 0.04% for 10 days, and in large animals at an oral dosage of 10-12 mg/kg bw for 5-7 days. 

Numerous episodes have occurred in which humans have developed drug-resistant nontyphoid Salmonella infections that have been traced to animal sources (23). These bacteria can be transmitted to humans in food or through direct contact with animals. Antimicrobial resistance limits the tlierapeutic options available to veterinarians and physicians for the subset of clinical cases of nontyphoid Salmonella that require treatment. A recent example is a clone of Salmonella typhimurium DT 104 with chromosomally encoded resistance to ampicillin, tetracycline, streptomycin, chloramphenicol and sulfonamides, which has become increasingly common in humans in England and Wales since 1990 (24). Since 1992, only Salmonella enteritidis has accounted for more cases of human salmonellosis than Salmonella typhimurium DT 104 (25, 26). Multiresistant DT 104 has currently emerged in several European countries (27-29) outbreaks have been also reported in the United States in both cattle (30) and humans (31). 

Common clinical manifestations of salmonella infection are diarrhea, fever, abdominal cramps. Most cases resolve within 4-7 days and the majority of patients recover without treatment. In certain cases, however. Salmonella infection may run a severe course, particularly in infants, elderly and patients with immunodeficiency. Bacteremia may develop and infection may affect multiple organs and sites with increased morbidity and mortality. 

Orally admiifistered trimethoprim is used in the treatment of chroific recurring urinary tract infection. Oral forms of trimethoprim-sulfamethoxazole are used in Shigella and some Salmonella infections, particularly when they are... 

Orally administered trimethoprim is used in the treatment of chronic recurring urinary tract infection. Oral forms of trimethoprim-sulfamethoxazole are used in Shigella and some Salmonella infections, particularly when they are resistant to ampicillin and chloramphenicol. High doses of oral trimethoprim-sulfamethoxazole are used in Pneumocystis pneumonia. This combination, along with polymyxin, has been shown to be effective in treating sepsis caused by Serratia or Pseudomonas organisms. 

Salmonella infections usually resolve in 5-7 days and often do not require treatment unless die patient becomes severely dehydrated or the infection spreads from the intestines. Persons with severe diarrhea may require rehydration, often with intravenous fluids. Antibiotics aie not usually necessary unless the infection spreads from the intestines, then it can be treated with ampicillin, gentamicin, irimethoprim/sulfamethoxazole, or ciprofloxacin. Unfortunately, some Salinoneila bacteria have become resistant to antibiotics, largely as a result of the use of antibiotics to promote the growth of feed animals. 

Hinton, M. and Linton, A.H. (1988) Control of Salmonella infections in broiler chickens by the acid treatment of their feed. Veterinary Record 123 416-421. 

Antibiotics have a recognized role in the treatment of culture-proven bacterial causes of symptomatic enteric infection such as Shigella spp., Campylobacter jejuni and Salmonella typhi. The use of antibiotics in the treatment... 

TMP-SMX is also used in the treatment of infection caused by ampicillin-resistant Shigella spp. and for antibiotic-resistant Salmonella spp.. The combination is also effective for covering the carrier state of Salmonella typhi, the agent of typhoid fever, and other Salmonella spp.. Successful treatment of traveler s diarrhea due to susceptible E. coli is another advantage of the use of this combination. The combination is not indicated in the therapy of enterohemorrhagic E. coli strains such as 0157 H7 because of the risk of developing hemolytic-uremic syndrome associated with the release of the cytotoxic enterotoxin by the drugs. 

Within the last few years, some new sulfa drugs have been introduced, including tnmethoprim-sulfamethoxazole. This drug has broadened the scope in treatment of urinary tract infections derived from species in addition to E. coli, namely, Klebsiella, Enterobacter, and Porteus species. This drug also is used for the treatment of acute otitis media in children, particularly those instances where strains uf H. influenzae and streptococcus pneumoniae may be suspected. The drug is also used to treat systemic infections that may arise from chloramphenicol- and ampicillin-rcsistant Salmonella as well as infections attributed to Pneumocystis carinii. 

Nitrofurans (NFs) are synthetic chemotherapeutic agents effective in the prevention and treatment of gastrointestinal infections caused by Escherichia Coli and Salmonella spp. Administered orally, usually as feed additives, they are widely used in treating cows, cattle, pigs, and poultry. 

Polymyxin B is effective against many gramnegative bacteria, including E. coli, Klebsiella, and Salmonella. Systemic administration of this drug, however, is often associated with extreme nephrotoxicity. Hence, this agent is used primarily for the treatment of local, superficial infections of the skin, eyes, and mucous membranes. When applied topically for these conditions, adverse reactions are relatively rare. Polymyxin B is often combined with other antibiotics such as bacitracin and neomycin in commercial topical preparations. 

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... 

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