Salmonella typhi infection, treatment

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. 

Salmonella typhi, S, pneumoniae. B. J rugilix, and N. meningitidis. Because of its penetration into the central nervous sy.stcm, chloramphenicol is a particularly important alternative therapy for meningitis. It is not recommended for the treatment of urinary tract infections bccau.se, i to 10% of the unconjugated form is excreted in the urine. Chloramphenicol is also used fur the treatment of rickettsial infections, such as Rocky Mountain spotted fever. 

Wain J, Hoa NT, Chinh NT, et al. Quinolone-resistant Salmonella typhi in Viet Nam Molecular basis of resistance and clinical response to treatment. Clin Infect Dis 1997 25 1404-1410. 

It is estimated that 3-5% of untreated patients become carriers of S. typhi. Chronic carriers pose a significant pool of infected individuals with Salmonella typhi, because they shed bacilli for a long period. The risk is enhanced since these carriers are difficult to identify because the majority are asymptomatic. Furthermore, Salmonella typhi colonize the gallbladder and biliary tree and they are excreted in the stool by the enterohepatic circulation. Even the removed of the gallbladder is not always an effective measure to abolish the carrier state, since Salmonella typhi spread to the intrahepatic bile ducts. Identification of carriers is important in order to contain and limit the transmission to healthy individuals. Carrier s state is confirmed by isolation of Salmonella typhi in stool culture. Treatment of carriers with amoxicilhn, trimethoprim-sulfamethoxazole or ciprofloxacin is indicated. 

Chloramphenicol is particularly recommended for the management and treatment of serious infections produced by the strains of both Gram-positive and Gram-negative organism that have developed eventually resistance to either ampicillin or penicillin G, for instance H. influenzae, Salmonella typhi, S. pneumoniae, B. fragilis, and N. meningitidis. 

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