Advice to Clinicians
Most patients with Salmonella diarrheal illness require only supportive care, including fluid replacement. However, antibiotic treatment can be appropriate for certain patients, such as those with severe diarrhea, extra-intestinal infections (for example, urinary tract infection), or other risk factors for invasive disease (1, 2). Common first-line oral antibiotics for susceptible Salmonella infections are fluoroquinolones (for adults) and azithromycin (for children). Ceftriaxone is an alternative first-line treatment agent.
The strain of Salmonella Infantis in this outbreak is multidrug-resistant and not susceptible to the common first-line antibiotics ciprofloxacin and ceftriaxone, as well as several other antibiotics (see below). Many patients in this outbreak had urinary tract infections with urine cultures that yielded Salmonella Infantis.
If you are considering antibiotic treatment for a patient with known or suspected Salmonella infection, consider the following:
- Obtain appropriate cultures (for example, stool, urine, blood).
- Order antimicrobial susceptibility testing of the Salmonella isolate to guide the choice of antibiotic.
- If Salmonella is identified by a culture-independent diagnostic test (CIDT), request a culture to obtain an isolate for antimicrobial susceptibility testing (this is called a reflex culture).
- Choose an antibiotic based on the results of antimicrobial susceptibility testing whenever possible.
- The strain of Salmonella Infantis in this outbreak is NOT susceptible to ciprofloxacin, ceftriaxone, or other antibiotics including ampicillin, chloramphenicol, fosfomycin, gentamicin, kanamycin, nalidixic acid, streptomycin, sulfisoxazole, trimethoprim-sulfamethoxazole, and tetracycline.
- The strain appears to be susceptible to azithromycin, amoxicillin-clavulanic acid, and meropenem.
- Consider consulting an infectious disease specialist for management of patients with multidrug-resistant or complicated Salmonella infections.
- Remind patients about careful hand hygiene after using the bathroom and before preparing meals, to prevent transmission to others.
- Note that some health departments require a negative stool test before a person can return to work in a high-risk setting, such as food preparation, childcare, or healthcare.
Further recommendations for treatment of Salmonella infection can be found on the CDC website.
References for clinicians
- 2017 IDSA Clinical Practice Guidelines for the Treatment and Management of Infectious Diarrhea
- Red Book (Report of the Committee on Infectious Diseases, American Academy of Pediatrics)
- Page last reviewed: October 17, 2018
- Page last updated: October 17, 2018
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