Norfloxacin Treatment of Salmonellosis Does Not Shorten the Carrier Stage

Carlstedt, Göran; Dahl, Per Erling; Niklasson, Per-Magnus; Gullberg, Kjell; Banck, G; Kahlmeter, Gunnar

doi:10.3109/00365549009027095

Cited by 26 publications

(12 citation statements)

References 7 publications

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“…These steps are laborintensive and can require a minimum of 48 to 72 h before results can be reported to the physician. This delay in turnaround time (TAT) often results in the use of empirical antibiotic therapy, which may be unnecessary or even detrimental to patient care (19)(20)(21)(22)(23). Specifically, the use of fluoroquinolones has been associated with prolonged shedding of Salmonella spp.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, the use of fluoroquinolones has been associated with prolonged shedding of Salmonella spp. in stool and an increased rate of resistance in Campylobacter spp., and the use of ␤-lactams, sulfonamides, and quinolones has been associated with an increased risk of HUS when used to treat STEC-associated enteritis (19)(20)(21)(22)(23). Therefore, the use of antibiotics for enteritis attributed to Salmonella spp.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Evaluation of a Real-Time PCR Assay for Identification of Salmonella, Shigella, Campylobacter (Campylobacter jejuni and C. coli), and Shiga Toxin-Producing Escherichia coli Isolates in Stool Specimens

et al. 2013

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e Enteric illness affects millions of individuals annually in the United States and results in >50,000 hospitalizations. The rapid and accurate identification of bacterial pathogens associated with gastroenteritis can aid acute patient management decisions, including the use of antibiotic therapy and infection control. This study compared the ProGastro SSCS multiplex real-time PCR assay (Gen-Probe Prodesse, San Diego, CA) to culture for the identification of Campylobacter spp. (Campylobacter jejuni and Campylobacter coli), Salmonella spp., and Shigella spp. and to broth enrichment followed by an FDA-cleared enzyme immunoassay (EIA) for the identification of Shiga toxin-producing Escherichia coli (STEC) isolates in stool specimens. Stool samples submitted in preservatives for routine culture and EIA were prospectively enrolled and tested at four clinical centers. Discrepancies between the ProGastro SSCS assay and culture or EIA were resolved using bidirectional sequencing. The overall prevalence of the pathogens as detected by culture was 5.6% (1.8% Campylobacter, 1.8% Salmonella, 1.3% Shigella, and 0.8% STEC). When results based on the ProGastro SSCS assay and bidirectional sequencing were applied, the overall prevalence increased to 8.3% (2.3% Campylobacter, 2.6% Salmonella, 1.8% Shigella, and 1.6% STEC). Following resolution of the discrepant results, the sensitivity of the ProGastro SSCS assay was 100% for all pathogens, and the specificities ranged from 99.4% to 100%. The sensitivity of culture compared to sequence-confirmed ProGastro SSCS results ranged from 52.9% to 76.9%, with the specificities ranging from 99.9% to 100%. Overall, these results suggest that the ProGastro SSCS assay is highly sensitive and specific in a clinical setting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of a Real-Time PCR Assay for Identification of Salmonella, Shigella, Campylobacter (Campylobacter jejuni and C. coli), and Shiga Toxin-Producing Escherichia coli Isolates in Stool Specimens

et al. 2013

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“…Unfortunately, this limited our ability to define the true duration of colonization and perhaps also the magnitude of the immune responses had they been allowed to clear the organism independently. Clinically, administration of antibiotics has been associated in some studies with prolonged duration of positive stool cultures or even symptomatic relapse in subjects with nontyphoidal Salmonella gastroenteritis (2,24,25). This was not observed in our study, perhaps in part because a 3-day course of an antibiotic with little effect on the anaerobic intestinal flora was used.…”

Section: Discussionmentioning

confidence: 99%

Pilot Study of phoP/phoQ -Deleted Salmonella enterica Serovar Typhimurium Expressing Helicobacter pylori Urease in Adult Volunteers

2000

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Attenuated Salmonella enterica serovar Typhi has been studied as an oral vaccine vector. Despite success with attenuated S. enterica serovar Typhimurium vectors in animals, early clinical trials of S. enterica serovar Typhi expressing heterologous antigens have shown that few subjects have detectable immune responses to vectored antigens. A previous clinical study of phoP/phoQ-deleted S. enterica serovar Typhi expressing Helicobacter pylori urease from a multicopy plasmid showed that none of eight subjects had detectable immune responses to the vectored antigen. In an attempt to further define the variables important for engendering immune responses to vectored antigens in humans, six volunteers were inoculated with 5 ؋ 10 7 to 8 ؋ 10 7 CFU of phoP/phoQdeleted S. enterica serovar Typhimurium expressing the same antigen. Two of the six volunteers had fever; none had diarrhea, bacteremia, or other serious side effects. The volunteers were more durably colonized than in previous studies of phoP/phoQ-deleted S. enterica serovar Typhi. Five of the six volunteers seroconverted to S. enterica serovar Typhimurium antigens and had strong evidence of anti-Salmonella mucosal immune responses by enzyme-linked immunospot studies. Three of six (three of five who seroconverted to Salmonella) had immune responses in the most sensitive assay of urease-specific immunoglobulin production by blood mononuclear cells in vitro. One of these had a fourfold or greater increase in end-point immunoglobulin titer in serum versus urease. Attenuated S. enterica serovar Typhimurium appears to be more effective than S. enterica serovar Typhi for engendering immune responses to urease. Data suggest that this may be related to a greater stability of antigen-expressing plasmid in S. enterica serovar Typhimurium and/or prolonged intestinal colonization. Specific factors unique to nontyphoidal salmonellae may also be important for stimulation of the gastrointestinal immune system. Attenuated salmonellae have been extensively studied as live bacterial vectors for delivery of heterologous antigens because these intracellular microorganisms stimulate humoral, mucosal, and cellular immune responses in humans and animals. A goal of these studies has been to develop multivalent oral vaccines based upon Salmonella enterica serovar Typhi for human use. The existence of the safe live attenuated vaccine strain Ty21a, an effective vaccine against typhoid fever, and the species specificity of S. enterica serovar Typhi for humans has focused investigative attention on this serotype. Most human studies of attenuated S. enterica serovar Typhi have been based on preclinical data obtained in the murine model of systemic salmonellosis in which BALB/c mice are infected orally with attenuated Salmonella enterica serovar Typhimurium. More recently, mice have been infected nasally with S. enterica serovar Typhi strains (8). Although murine experiments are useful screening studies, their predictive value in forecasting immunogenicity and safety in clinical trials of atte...

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“…However, comparative observational studies [11][12][13][14][15][16] and a systematic review [17] of randomized, controlled trials [18][19][20][21][22][23][24][25][26][27][28] show that antimicrobial therapy has no effect on intestinal NTS in patients with diarrhea and may even cause prolonged excretion and emergence of drug-resistant bacteria. In a review of 15 controlled trials [17], only 3 [26][27][28] included asymptomatic NTS carriers (all without data for subgroup analyses), accounting for only 7% of the participants in the review.…”

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confidence: 99%

Norfloxacin and Azithromycin for Treatment of Nontyphoidal Salmonella Carriers

Sirinavin

Thavornnunth

Sakchainanont

et al. 2003

Clinical Infectious Diseases

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There has been inadequate evaluation of an antibiotic for eradication of nontyphoidal salmonellae (NTS) in asymptomatic carriers. In a randomized, placebo-controlled trial, such efficacy was evaluated using 2 five-day regimens (norfloxacin, 400 mg twice per day, and azithromycin, 500 mg once per day) compared with placebo. The study included 265 food workers in an area of Thailand where NTS are endemic who were asymptomatic NTS carriers. The presence of NTS in stool samples was assessed on days 7, 30, 60, and 90 after start of treatment. At each assessment visit, <4% of participants in each of the 3 groups carried an initial Salmonella serotype; 16%-35% had new Salmonella serotypes detected, except on day 7 in the azithromycin group, when the rate was 4%. Sanitation was good at work but not at home. Selection of multidrug-resistant Salmonella enterica serotype Schwarzengrund was demonstrated. The study regimens were not better than placebo for treatment of asymptomatic food workers who carried NTS in an area where these organisms are endemic, and use of the regimens resulted in antimicrobial resistance.

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Norfloxacin Treatment of Salmonellosis Does Not Shorten the Carrier Stage

Cited by 26 publications

References 7 publications

Clinical Evaluation of a Real-Time PCR Assay for Identification of Salmonella, Shigella, Campylobacter (Campylobacter jejuni and C. coli), and Shiga Toxin-Producing Escherichia coli Isolates in Stool Specimens

Clinical Evaluation of a Real-Time PCR Assay for Identification of Salmonella, Shigella, Campylobacter (Campylobacter jejuni and C. coli), and Shiga Toxin-Producing Escherichia coli Isolates in Stool Specimens

Pilot Study of phoP/phoQ -Deleted Salmonella enterica Serovar Typhimurium Expressing Helicobacter pylori Urease in Adult Volunteers

Norfloxacin and Azithromycin for Treatment of Nontyphoidal Salmonella Carriers

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