Antimicrobials for treating symptomatic non-typhoidal Salmonella infection

Abstract

Background Non-typhoidal Salmonella (NTS) commonly causes diarrhoea, and is usually self-limiting, although sometimes people become ill with sepsis and dehydration. Routine antibiotic use for this infection could result in persistent colonization and the spread of resistant bacterial strains. Objectives To assess the e icacy and safety of giving antibiotics to people with NTS diarrhoea. Search methods We searched the Cochrane Infectious Diseases Group trials register (up to August 2012), the Cochrane Controlled Trials Register (CENTRAL) published in The Cochrane Library (up to Issue 8 2012); and MEDLINE, African Index Medicus, CINAHL, EMBASE, LILACS, and the Science Citation Index, all up to 6 August 2012. We also searched the metaRegister of Controlled Trials (mRCT) for both completed and on going trials and reference lists of relevant articles. Selection criteria Randomized controlled trials (RCTs) comparing any antibiotic treatment for diarrhoea caused by NTS species with placebo or no antibiotic treatment. We selected trials that included people of all ages who were symptomatic for NTS infection. Examples of symptoms included fever, abdominal pain, vomiting and diarrhoea. We excluded trials where the outcomes were not reported separately for the NTS subgroup of patients. Two review authors independently applied eligibility criteria prior to study inclusion. Data collection and analysis Two review authors independently extracted data on pre-specified outcomes and independently assessed the risk of bias of included studies. The primary outcome was the presence of diarrhoea between two to four days a er treatment. The quality of evidence was assessed using the GRADE methods. Main results Twelve trials involving 767 participants were included. No di erences were detected between the antibiotic and placebo/no treatment arms for people with diarrhoea at two to four days a er treatment (risk ratio (RR) 1.75, 95% confidence interval (CI) 0.42 to 7.21; one trial, 46 participants; very low quality evidence). No di erence was detected for the presence of diarrhoea at five to seven days a er treatment Antimicrobials for treating symptomatic non-typhoidal Salmonella infection (Review)

Salmonella Infections in Childhood

“…Antimicrobials are not recommended for treatment of immunocompetent adults or children more than 1 year of age who present with mild to moderate gastroenteritis caused by Salmonella. This recommendation is supported by a meta-analysis of 12 trials that found no significant benefit from antibiotic therapy on the duration of illness, diarrhea, or fever [57]. Antibiotic therapy has not been shown to shorten the duration of symptoms and in fact may prolong colonization and carrier stage.…”

“…In infants less than 3 months of age, antimicrobial treatment is recommended because these patients are at higher risk for bacteremia and extra-intestinal complications such as meningitis and osteomyelitis [40][41][42]58]. Use of antimicrobials should also be considered in children with underlying medical conditions, such as HIV infection, primary immunodeficiency disorders, sickle cell anemia, chronic gastrointestinal disease, and cancer; nevertheless, the efficacy of this measure is unproven [57].…”

“…However, fluoroquinolones are not approved by the FDA for this indication in people younger than 18 years of age and are not recommended unless the benefits of therapy outweigh the potential risks with use of the drug [58]. The 2012 meta-analysis for treating NTS infection did not find studies that evaluated the effect of fluoroquinolones in infants and young children [57]. Resistance to ampicillin, amoxicillin, and trimethoprimsulfamethoxazole is more common in developing countries.…”

Phenotypic Characterization of Salmonella Isolated from Food Production Environments Associated with Low–Water Activity Foods

“…Resistance to antibiotics has strong implications for the clinical treatment of severe cases of salmonellosis (28). No statistically significant correlations were observed between resistance to antibiotics and survival in low-aw broths, suggesting that Salmonella exposed to these low water environments, in this collection, would not have increased survival after antibiotic treatment.…”

Bacterial Infections of the Small and Large Intestine

“…These include neonates and young infants (< 6 months) and children with underlying immune deficiency, anatomical or functional asplenia, corticosteroid or immunosuppressive therapy, IBD, or achlorhydria (weak recommendation, low-quality evidence). A Cochrane systematic review showed that antibiotic therapy of Salmonella gastroenteritis does not significantly affect the duration of fever or diarrhea in otherwise healthy children or adults compared to placebo or no treatment [76]. Moreover, antibiotics were associated with a significant increase of carriage of Salmonella, although other adverse events were not reported.…”