Salmonellosis medical therapy: Difference between revisions
Sergekorjian (talk | contribs) |
Sergekorjian (talk | contribs) |
||
| Line 62: | Line 62: | ||
! style="background: #4479BA; padding: 2px 2px;" rowspan=1 | {{fontcolor|#FFFFFF|Children}} | ! style="background: #4479BA; padding: 2px 2px;" rowspan=1 | {{fontcolor|#FFFFFF|Children}} | ||
|- | |- | ||
| 5 mg/kg ([[trimethoprim]]) + 25 mg/kg ([[sulfamethoxazole]]) twice/day, during 3 days | | style="padding: 5px 5px; background: #F5F5F5;" | 5 mg/kg ([[trimethoprim]]) + 25 mg/kg ([[sulfamethoxazole]]) twice/day, during 3 days | ||
|- | |- | ||
! style="background: #4479BA; padding: 2px 2px;" rowspan=1 | {{fontcolor|#FFFFFF|Adults}} | ! style="background: #4479BA; padding: 2px 2px;" rowspan=1 | {{fontcolor|#FFFFFF|Adults}} | ||
|- | |- | ||
| 160 mg ([[trimethoprim]]) + 800 mg ([[sulfamethoxazole]]) twice/day, during 3 days | | style="padding: 5px 5px; background: #F5F5F5;" | 160 mg ([[trimethoprim]]) + 800 mg ([[sulfamethoxazole]]) twice/day, during 3 days | ||
|} | |} | ||
| Line 74: | Line 74: | ||
! style="background: #4479BA; padding: 2px 2px;" rowspan=1 | {{fontcolor|#FFFFFF|Adults}} | ! style="background: #4479BA; padding: 2px 2px;" rowspan=1 | {{fontcolor|#FFFFFF|Adults}} | ||
|- | |- | ||
|[[Ciprofloxacin]] - 500 mg PO twice/day, during 1 to 3 days | | style="padding: 5px 5px; background: #F5F5F5;" | [[Ciprofloxacin]] - 500 mg PO twice/day, during 1 to 3 days | ||
|- | |- | ||
|[[Norfloxacin]] - 400 mg PO twice/day, during 1 to 3 days | |style="padding: 5px 5px; background: #F5F5F5;" | [[Norfloxacin]] - 400 mg PO twice/day, during 1 to 3 days | ||
|- | |- | ||
|[[Levofloxacin]] - 500 mg PO once/day, during 1 to 3 days | | style="padding: 5px 5px; background: #F5F5F5;" | [[Levofloxacin]] - 500 mg PO once/day, during 1 to 3 days | ||
|- | |- | ||
|[[Ofloxacin]] - 300 mg twice/day, during 1 to 3 days | | style="padding: 5px 5px; background: #F5F5F5;" | [[Ofloxacin]] - 300 mg twice/day, during 1 to 3 days | ||
|} | |} | ||
| Line 91: | Line 88: | ||
! style="background: #4479BA; padding: 2px 2px;" rowspan=1 | {{fontcolor|#FFFFFF|Children <12 years old}} | ! style="background: #4479BA; padding: 2px 2px;" rowspan=1 | {{fontcolor|#FFFFFF|Children <12 years old}} | ||
|- | |- | ||
| 50-75 mg/kg body weight/day in 1 or 2 doses | | style="padding: 5px 5px; background: #F5F5F5;" | 50-75 mg/kg body weight/day in 1 or 2 doses | ||
|- | |- | ||
! style="background: #4479BA; padding: 2px 2px;" rowspan=1 | {{fontcolor|#FFFFFF|Adults}} | ! style="background: #4479BA; padding: 2px 2px;" rowspan=1 | {{fontcolor|#FFFFFF|Adults}} | ||
|- | |- | ||
| 100 mg/Kg body weight/day in 1 or 2 doses | | style="padding: 5px 5px; background: #F5F5F5;" | 100 mg/Kg body weight/day in 1 or 2 doses | ||
|} | |} | ||
Revision as of 14:07, 27 August 2014
|
Salmonellosis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Salmonellosis medical therapy On the Web |
|
American Roentgen Ray Society Images of Salmonellosis medical therapy |
|
Risk calculators and risk factors for Salmonellosis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Jolanta Marszalek, M.D. [3]
Overview
Treatment of uncomplicated salmonellosis is supportive, with electrolyte replacement, rehydration and adequate nutrition. Symptomatic treatment of the diarrhea may include loperamide or bismuth subsalicylate. Severe cases of the disease, and certain groups of patients, such as infants, elderly, or immunocompromised may require antibiotic treatment. When indicated, antibiotics for salmonellosis may include: trimethoprim-sulfamethoxazole, fluoroquinolones, or ceftriaxone. Follow-up with fecal cultures is not indicated after resolution of the disease.
Medical Therapy
Mild cases of salmonelloses usually resolve within 5 to 7 days. Patients with severe cases of the disease may require rehydration with intravenous fluids. Antibiotic treatment is not routinely recommended, unless the patient becomes severely dehydrated, belongs to one of the risk groups described below, or the infection reaches the blood stream.[1]
Salmonellosis commonly presents with unspecific gastrointestinal symptoms, such as diarrhea, fever, and abdominal pain. Antibiotic treatment of infectious diarrhea is considered controversial because:[2]
- Symptoms may be caused by different types of enteric pathogens, what makes the initial treatment of severe cases often "empiric"
- Antibiotic treatment of non-typhoidal salmonellosis prolongs shedding of the bacteria in feces
Supportive Therapy
Initial therapy of infectious diarrhea, irrespectively to the causative agent, should start with rehydration. Oral rehydration with a glucose and electrolyte solution is preferred, except in cases where the patient is severely dehydrated or comatose. [3]
Nutritional support should also be provided, particularly in children, where it was shown to improve outcomes. The use of the "BRAT diet" is also frequently recommended. This diet consists of bananas, rice, applesauce and toast, with avoidance of dairy products, due to the potential deficiency of lactase, following the gastrointestinal disturbance.[3][4]
Symptomatic Therapy
Although there is little evidence of the efficacy of most of the antidiarrheal agents on the marker, the following have demonstrated to be effective in controlled, randomized trials:[3][5]
- Loperamide
Antimotility agent, with anti-secretory properties, able to inhibit intestinal peristalsis. Despite being an opiate, it does not have the potential of addiction, since it does not penetrate the nervous system.[6]
Loperamide should be avoided in patients with inflammatory or bloody diarrhea because of the relation between antimotility agents and prolonged fever in patients infected with Shigella and C. difficile (other potential causative agents of infectious diarrhea).[7]
- Bismuth Subsalicylate
Bismuth subsalicylate may alleviate symptoms such as: nausea, diarrhea and abdominal pain.[8] It was also shown to decrease stool output in pediatric patients.[9]
Antibiotic Therapy
Indications
Antibiotics are not recommended for uncomplicated salmonellosis because they prolong shedding of the bacteria, typically do not alleviate the diarrhea, and have been associated with relapse.[3][10][11] Antibiotic therapy is only indicated for patients with severe cases of the disease, and for those with risk factors for extra-intestinal infection, after blood and fecal cultures have been obtained. Risk groups for the development of severe disease, and extra-intestinal manifestations include:[2][3][12]
- Infants and elderly
- Patients with pernicious anemia
- Patients taking H2 antagonists and antacids
- Changes in endogenous bowel flora, in:
- Surgery
- Recent antibiotic treatment
- Diabetes
- HIV infection
- Malignancy
- Valvular heart disease
- Rheumatological diseases
- Blockage of reticuloendothelial system
- Transplant recipients
- Immunosuppressive therapy
- Lymphoprolipherative disease
- Hemoglobinopathies
- Prosthetic devices, such as artificial joints
Antibiotic treatment may be indicated in cases when rapid interruption of fecal shedding of the bacteria is required to avoid outbreaks in institutions.[13]
Recommended Agents
For the cases where antibiotics are indicated, treatment should include one of the following:[3][14]
- Trimethoprim-Sulfamethoxazole
Indicated for children, and when susceptibility is suspected
| Children |
|---|
| 5 mg/kg (trimethoprim) + 25 mg/kg (sulfamethoxazole) twice/day, during 3 days |
| Adults |
| 160 mg (trimethoprim) + 800 mg (sulfamethoxazole) twice/day, during 3 days |
- Fluoroquinolones
| Adults |
|---|
| Ciprofloxacin - 500 mg PO twice/day, during 1 to 3 days |
| Norfloxacin - 400 mg PO twice/day, during 1 to 3 days |
| Levofloxacin - 500 mg PO once/day, during 1 to 3 days |
| Ofloxacin - 300 mg twice/day, during 1 to 3 days |
- Ceftriaxone
| Children <12 years old |
|---|
| 50-75 mg/kg body weight/day in 1 or 2 doses |
| Adults |
| 100 mg/Kg body weight/day in 1 or 2 doses |
For immunocompromised patients, the duration of the antibiotic treatment described above should be prolonged for 14 days, or longer in case of relapse.[14]
Multidrug Resistance
Some serovars of Salmonella enterica, particularly Typhimurium and Newport, are linked to more severe cases of salmonellosis and multi-drug resistance.[12]
Follow Up
Fecal cultures are not indicated for patient follow-up after uncomplicated cases of salmonellosis, irrespectively to the treatment administrated. The results tend to be intermittently positive for a long period of time, and do not show any utility in asymptomatic patients.[2][15]
References
- ↑ "Salmonella (non-typhoidal)".
- ↑ 2.0 2.1 2.2 Hohmann EL (2001). "Nontyphoidal salmonellosis". Clin Infect Dis. 32 (2): 263–9. doi:10.1086/318457. PMID 11170916.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.
- ↑ "Managing Acute Gastroenteritis Among Children Oral Rehydration, Maintenance, and Nutritional Therapy".
- ↑ "Antidiarrheal Drug Products for Over-the-Counter Human Use; Amendment of Final Monograph".
- ↑ DuPont HL, Flores Sanchez J, Ericsson CD, Mendiola Gomez J, DuPont MW, Cruz Luna A; et al. (1990). "Comparative efficacy of loperamide hydrochloride and bismuth subsalicylate in the management of acute diarrhea". Am J Med. 88 (6A): 15S–19S. PMID 2192553.
- ↑ DuPont HL, Hornick RB (1973). "Adverse effect of lomotil therapy in shigellosis". JAMA. 226 (13): 1525–8. PMID 4587313.
- ↑ DuPont HL, Sullivan P, Pickering LK, Haynes G, Ackerman PB (1977). "Symptomatic treatment of diarrhea with bismuth subsalicylate among students attending a Mexican university". Gastroenterology. 73 (4 Pt 1): 715–8. PMID 330307.
- ↑ Figueroa-Quintanilla D, Salazar-Lindo E, Sack RB, León-Barúa R, Sarabia-Arce S, Campos-Sánchez M; et al. (1993). "A controlled trial of bismuth subsalicylate in infants with acute watery diarrheal disease". N Engl J Med. 328 (23): 1653–8. doi:10.1056/NEJM199306103282301. PMID 8487823.
- ↑ Wiström J, Jertborn M, Ekwall E, Norlin K, Söderquist B, Strömberg A; et al. (1992). "Empiric treatment of acute diarrheal disease with norfloxacin. A randomized, placebo-controlled study. Swedish Study Group". Ann Intern Med. 117 (3): 202–8. PMID 1616214.
- ↑ Neill MA, Opal SM, Heelan J, Giusti R, Cassidy JE, White R; et al. (1991). "Failure of ciprofloxacin to eradicate convalescent fecal excretion after acute salmonellosis: experience during an outbreak in health care workers". Ann Intern Med. 114 (3): 195–9. PMID 1898630.
- ↑ 12.0 12.1 Gal-Mor O, Boyle EC, Grassl GA (2014). "Same species, different diseases: how and why typhoidal and non-typhoidal Salmonella enterica serovars differ". Front Microbiol. 5: 391. doi:10.3389/fmicb.2014.00391. PMID 25136336.
- ↑ Lightfoot NF, Ahmad F, Cowden J (1990). "Management of institutional outbreaks of Salmonella gastroenteritis". J Antimicrob Chemother. 26 Suppl F: 37–46. PMID 2292544.
- ↑ 14.0 14.1 Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV; et al. (2001). "Practice guidelines for the management of infectious diarrhea". Clin Infect Dis. 32 (3): 331–51. doi:10.1086/318514. PMID 11170940.
- ↑ Buchwald DS, Blaser MJ (1984). "A review of human salmonellosis: II. Duration of excretion following infection with nontyphi Salmonella". Rev Infect Dis. 6 (3): 345–56. PMID 6377442.