Cefotaxime‐Ciprofloxacin Combination Therapy for Nontyphoid Salmonella Bacteremia and Paravertebral Abscess After Failure of Monotherapy

Abstract

Therapeutic failure of monotherapy with either a third-generation cephalosporin or a fluoroquinolone against nontyphoid salmonellae has been observed in clinical practice. Combination therapy with both agents is recommended in the literature for treating life-threatening infections. However, we know of no published case reports that indicate a therapeutic advantage of this combination therapy for nontyphoid salmonellae infections. We describe a 60-year-old man who had breakthrough bacteremia with vertebral osteomyelitis and paravertebral abscess caused by Salmonella enterica serotype Choleraesuis. This was not controlled with sequential monotherapy but was eventually cured with cefotaxime-ciprofloxacin combination therapy. The Etest showed that the strain was susceptible to cefotaxime and ciprofloxacin, but resistant to nalidixic acid. Cefotaxime and ciprofloxacin in combination may be considered as an option for difficult-to-treat salmonellosis.

Serovars and antimicrobial resistance of non‐typhoidal Salmonella isolated from non‐diarrhoeic dogs in Grenada, West Indies

“…Combination therapy with cefotaxime and ciprofloxacin has been successful for non‐typhoidal Salmonella bacteremia (Chang et al . ).…”

“…However, intermediate susceptibility to cefotaxime and tetracycline among isolates from green iguanas was of concern (Sylvester et al 2014a). Combination therapy with cefotaxime and ciprofloxacin has been successful for non-typhoidal Salmonella bacteremia (Chang et al 2006).…”

Look what’s eroding through the chest wall? Salmonella osteomyelitis of the ribs in an immunocompetent adult not associated with sickle cell disease

“…Penicillins, chloramphenicol, third-generation cephalosporins, aminoglycosides and quinolones are all useful alone or in combination treatment for salmonella osteomyelitis. 9 There are, however, cases of microbial resistance with the development of chronic infection. Our patient was treated successfully with repeated wide surgical resection and subsequent parenteral antibiotics.…”

In vitro combination of cefotaxime and ciprofloxacin against non-typhoid salmonellae

“…Although a higher ciprofloxacin MIC is associated with clinical treatment failure of fluoroquinolone monotherapy [7], successful treatment with combination therapy with cefotaxime and ciprofloxacin was observed in a case of bacteraemia with spinal osteomyelitis and epidural abscess caused by one of the study strains (SI-214) [2]. The relationship between the MIC of ciprofloxacin and the overall effect of the combination needs further study.…”

“…However, therapeutic failure with monotherapy against salmonellae has been observed in clinical practice. Combination therapy with both agents is suggested to treat life-threatening infections until susceptibility data are available [1,2], but there is no convincing evidence indicating a therapeutic advantage of combination therapy.…”