Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012 Nov 14;11(11):CD001167.
doi: 10.1002/14651858.CD001167.pub2.

Antimicrobials for treating symptomatic non-typhoidal Salmonella infection

Ifeanyi A Onwuezobe  1 , Philip O Oshun, Chibuzo C Odigwe
Affiliations
Review

Antimicrobials for treating symptomatic non-typhoidal Salmonella infection

Ifeanyi A Onwuezobe et al. Cochrane Database Syst Rev. .

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 efficacy 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 after treatment. The quality of evidence was assessed using the GRADE methods.

Main results: Twelve trials involving 767 participants were included. No differences were detected between the antibiotic and placebo/no treatment arms for people with diarrhoea at two to four days after treatment (risk ratio (RR) 1.75, 95% confidence interval (CI) 0.42 to 7.21; one trial, 46 participants; very low quality evidence). No difference was detected for the presence of diarrhoea at five to seven days after treatment (RR 0.83, 95% CI 0.62 to 1.12; two trials, 192 participants; very low quality evidence), clinical failure (RR 0.88, 95% CI 0.62 to 1.25; seven trials, 440 participants; very low quality evidence). The mean difference for diarrhoea was 0 days (95% CI -0.54 to 0.54; 202 participants, four studies; low quality evidence);for fever was 0.27 days (95% CI -0.11 to 0.65; 107 participants, two studies; very low quality evidence); and for duration of illness was 0 days (95% CI -0.68 to 0.68; 116 participants, two studies; very low quality evidence). Quinolone antibiotic treatment resulted in a significantly higher number of negative stool cultures for NTS during the first week of treatment (microbiological failure: RR 0.33, 95% CI 0.20 to 0.56; 166 participants, four trials).Antibiotic treatment meant passage of the same Salmonella serovar one month after treatment was almost twice as likely (RR 1.96, 95% CI 1.29 to 2.98; 112 participants, three trials), which was statistically significant. Non-severe adverse drug reactions were more common among the patients who received antibiotic treatment.

Authors' conclusions: There is no evidence of benefit for antibiotics in NTS diarrhoea in otherwise healthy people. We are uncertain of the effects in very young people, very old people, and in people with severe and extraintestinal disease. A slightly higher number of adverse events were noted in people who received antibiotic treatment for NTS.

PubMed Disclaimer

Conflict of interest statement

We declare that we have no conflicts of interest.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Antibiotics versus placebo or no treatment, Outcome 1 Presence of diarrhoea at 2 to 4 days.
1.2
1.2. Analysis
Comparison 1 Antibiotics versus placebo or no treatment, Outcome 2 Duration of diarrhoea.
1.3
1.3. Analysis
Comparison 1 Antibiotics versus placebo or no treatment, Outcome 3 Presence of diarrhoea at 5 to 7 days.
1.4
1.4. Analysis
Comparison 1 Antibiotics versus placebo or no treatment, Outcome 4 Clinical failure.
1.5
1.5. Analysis
Comparison 1 Antibiotics versus placebo or no treatment, Outcome 5 Duration of fever.
1.6
1.6. Analysis
Comparison 1 Antibiotics versus placebo or no treatment, Outcome 6 Duration of illness.
1.7
1.7. Analysis
Comparison 1 Antibiotics versus placebo or no treatment, Outcome 7 Microbiological failure.
1.8
1.8. Analysis
Comparison 1 Antibiotics versus placebo or no treatment, Outcome 8 Fecal carriage of the same Salmonella serovar after 1 month following the end of antibiotic treatment.
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Butler 1993 {published data only}
    1. Butler T, Lolekha S, Rasidi C, Kadio A, Leal del Rosal P, Iskandar H, et al. Treatment of acute bacterial diarrhea: a multicenter international trial comparing placebo with fleroxacin given as a single dose or once daily for 3 days. American Journal of Medicine 1993;94(Suppl 3A):187s‐94s. - PubMed
Chiu 1999 {published data only}
    1. Chiu C, Lin T, Ou JT. A clinical trial comparing oral azithromycin, cefixime, and no antibiotics in the treatment of acute uncomplicated Salmonella enteritis in children. Journal of Pediatrics and Child Health 1999;35(4):372‐4. - PubMed
Garcia de Olarte 1974 {published data only}
    1. Garcia de Olarte D, Trujillo H, Agudelo N, Nelson JD, Haltalin KC. Treatment of diarrhea in malnourished infants and children: a double blind study comparing ampicillin and placebo. American Journal of Disease in Childhood 1974;127(3):379‐88. - PubMed
Goodman 1990 {published data only}
    1. Goodman LJ, Trenholme GM, Kaplan RL, Segreti J, Hines D, Petrak R, et al. Empiric antimicrobial therapy of domestically acquired acute diarrhea in urban adults. Archives of Internal Medicine 1990;150(3):541‐6. - PubMed
Joint Project ASID 1970 {published data only}
    1. Joint project by members of the Association for the Study of Infectious Disease. Effect of neomycin in non‐invasive Salmonella infections of the gastrointestinal tract. Lancet 1970;2(7684):1159‐61. - PubMed
Kazemi 1973 {published data only}
    1. Kazemi M, Gumpert TG, Marks MI. A controlled trial comparing sulfamethoxazole‐trimethoprim, ampicillin, and no therapy in the treatment ofSalmonella gastroenteritis in children. Journal of Pediatrics 1973;83(4):646‐50. - PubMed
Macdonald 1954 {published data only}
    1. Macdonald WB, Friday F, McEacharn M. The effect of chloramphenicol in Salmonella enteritis of infancy. Archives of Disease in Childhood 1954;29(145):238‐41. - PMC - PubMed
Neil 1991 {published data only}
    1. Neill MA, Opal SM, Heelan J, Giusti R, Cassidy JE, White R, et al. Failure of ciprofloxacin to eradicate convalescent fecal excretion after acute salmonellosis: experience during an outbreak in health care workers. Annals of Internal Medicine 1991;114(3):195‐9. - PubMed
Nelson 1980 {published data only}
    1. Nelson JD, Kusmiesz H, Jackson LH, Woodman E. Treatment of Salmonella gastroenteritis with ampicillin, amoxicillin or placebo. Pediatrics 1980;65(6):1125‐30. - PubMed
Pitkajarvi 1996 {published data only}
    1. Pitkajarvi T, Kujanne E, Sillantaka I, Lumio J. Norfloxacin and Salmonella excretion in acute gastroenteritis ‐ a 6 month follow‐up study. Scandinavian Journal of Infectious Diseases 1996;28(2):177‐80. - PubMed
Sanchez 1993 {published data only}
    1. Sanchez C, Garcia‐Restoy E, Garau J, Bella F, Freixas N, Simo M, et al. Ciprofloxacin and trimethoprim‐sulfamethoxazole versus placebo in acute uncomplicated Salmonella enteritis: a double blind trial. Journal of Infectious Diseases 1993;168(5):1304‐7. - PubMed
Wistrom 1992 {published data only}
    1. Wistrom J, Jertborn M, Ekwall E, Norlin K, Soderquist B, Stromberg A, et al. Empiric treatment of acute diarrheal disease with norfloxacin. Annals of Internal Medicine 1992;117(3):202‐8. - PubMed

References to studies excluded from this review

Bessudo 1972 {published data only}
    1. Bessudo D, Herrera Duarte A, Bucio R. Rifampicin in eradication of Salmonella from the intestinal tract. Chemotherapy 1972;17(1):71‐8. - PubMed
Carlstedt 1990 {published data only}
    1. Carlstedt G, Dahl P, Niklasson PM, Gullberg K, Banck G, Kahlmeter G. Norfloxacin treatment of salmonellosis does not shorten the carrier stage. Scandinavian Journal of Infectious Diseases 1990;22(5):553‐6. - PubMed
Dryden 1996 {published data only}
    1. Dryden MS, Gabb RJE, Wright SK. Empirical treatment of severe acute community‐acquired gastroenteritis with ciprofloxacin. Clinical Infectious Diseases 1996;22(6):1019‐25. - PubMed
Ericsson 1983 {published data only}
    1. Ericsson CD, Dupont HL, Sullivan P, Galindo E, Evans DG, Evans DJ Jr. Bizacomycin, a poorly absorbable antibiotic, effectively treats traveller's diarrhea. Annals of Internal Medicine 1983;98(1):20‐5. - PubMed
Hatalin 1972 {published data only}
    1. Hatalin KC, Kusmiesz HT, Hinton LV, Nelson JD. Treatment of acute diarrhea in outpatients: double‐blind study comparing ampicillin and placebo. American Journal of Disease in Childhood 1972;124(4):554‐61. - PubMed
Lolekha 1988 {published data only}
    1. Lolekha S, Patanachareon S, Thanangkul B, Vibulbandhitkit S. Norfloxacin versus co‐trimoxazole in the treatment of acute bacterial diarrhoea: a placebo controlled study. Scandinavian Journal of Infectious Diseases 1988;56(suppl):35‐45. - PubMed
Mattila 1993 {published data only}
    1. Mattila L, Peltola H, Siitonen A, Kyronseppa H, Simula I, Kataja M. Short‐term treatment of traveller's diarrhea with norfloxacin: a double‐blind placebo controlled study during two seasons. Clinical Infectious Diseases 1993;17(4):779‐82. - PubMed
Mensa 1989 {published data only}
    1. Mensa J, Moreno A, Segura F, Escofet C, Serrate G, Baga R, et al. Acute enteritis caused by Salmonella: effect of mecillinam and cotrimoxazol on the clinical course and fecal carrier state [Enteritis Aguda por Salmonella: influencia del mecillinam y del cotrimoxazol en el curso clinico y en el estado de portado fecal]. Medicina Clinica 1989;93(5):161‐8. - PubMed
Noguerado 1995 {published data only}
    1. Noguerado A, Garcia‐Polo I, Isasia T, Jimenez ML, Bermudez P, Pita J, et al. Early single dose therapy with ofloxacin for empirical treatment of acute gastroenteritis: a randomized, placebo‐controlled double blind clinical trial. Journal of Antimicrobial Chemotherapy 1995;36(4):665‐72. - PubMed
Pichler 1986 {published data only}
    1. Pichler H, Diridl G, Wolf D. Ciprofloxacin in the treatment of acute bacterial diarrhea: a double blind study. European Journal of Clinical Microbiology 1986;5(2):241‐3. - PubMed
Pichler 1987 {published data only}
    1. Pichler HE, Diridl G, Stickler K, Wolf D. Clinical efficacy of ciprofloxacin compared with placebo in bacterial diarrhea. American Journal of Medicine 1987;82(4A):329‐32. - PubMed
Robins‐Browne 1983 {published data only}
    1. Robins‐Browne RM, Coovadia HM, Bodasing MN, Mackenjee MK. Treatment of acute non‐specific gastroenteritis of infants and young children with erythromycin. American Journal of Tropical Medicine and Hygiene 1983;32(4):886‐90. - PubMed
Sirinavin 2003 {published data only}
    1. Sirinavin S, Thavornnunth J, Sakchainanont B, Bangtrakulnonth A, Chongthawonsatid S, Junumporn S. Norfloxacin and azithromycin for treatment of nontyphoidal Salmonella carriers. Clinical Infectious Diseases 2003;37(5):685‐91. - PubMed
Svenungsson 1990 {published data only}
    1. Svenungsson B, Ekwall E, Hansson HB. Efficacy of the combination pivampicillin/pivmecillinam compared to placebo in the treatment of convalescent carriers of nontyphi Salmonella. Infection 1990;18(3):163‐5. - PubMed
Taylor 2006 {published and unpublished data}
    1. Taylor DN, Bourgeois AL, Ericsson CD, Steffen R, Jiang ZD, Halpern J, et al. A randomized double blind, multicenter study of rifaximin compared with placebo and with ciprofloxacin in the treatment of travelers' diarrhea. American Journal of Tropical Medicine and Hygiene 2006;74(6):1060‐66. - PubMed
Wolfsdorf 1973 {published data only}
    1. Wolfsdorf J, Myer EC. Trimethoprim‐sulphonamide mixture in the treatment of infantile gastro‐enteritis. South African Medical Journal 1973;47(40):1887‐9. - PubMed

References to ongoing studies

Tsai 2012 {published and unpublished data}
    1. Tsai MH. The Role of Short‐course Ceftriaxone Therapy in the Treatment of Severe Nontyphoidal Salmonella Enterocolitis. 2012.

Additional references

Boyle 2007
    1. Boyle EC, Bishop JL, Grassl GA, Finlay BB. Salmonella: from pathogenesis to therapeutics. Journal of Bacteriology 2007;189(5):1489‐95. - PMC - PubMed
Buchwald 1984
    1. Buchwald DS, Blaser MJ. A review of human salmonellosis: II. Duration of excretion following infection with nontyphi Salmonella. Reviews of infectious Diseases 1984;6(3):345‐56. - PubMed
Chen 2007
    1. Chen PL, Chang CM, Wu CJ, Ko NY, Lee NY, Lee HC, et al. Extraintestinal focal infections in adults with nontyphoid Salmonella bacteraemia: predisposing factors and clinical outcome. Journal of Internal Medicine 2007;261(1):91‐100. - PubMed
Diez Dorado 2004
    1. Díez Dorado R, Tagarro García A, Baquero‐Artigao F, García‐Miguel MJ, Uría González MJ, Peña García P, et al. Non‐typhi Salmonella bacteremia in children: an 11‐year review. Anales de Pediatría (Barcelona, Spain) 2004;60(4):344‐8. - PubMed
Effa 2011
    1. Effa EE, Lassi ZS, Critchley JA, Garner P, Sinclair D, Olliaro PL, et al. Fluoroquinolones for treating typhoid and paratyphoid fever (enteric fever). Cochrane Database of Systematic Reviews 2011, Issue 10. [DOI: 10.1002/14651858.CD004530.pub4] - DOI - PMC - PubMed
Frost 1996
    1. Frost JA, Kellehr A, Rowe B. Increasing resistance in Salmonella in England and Wales 1991‐1994. Journal of Antimicrobial Chemotherapy 1996;37(1):85‐91. - PubMed
Gordon 2002
    1. Gordon MA, Banda HT, Gondwe M, Gordon SB, Boeree MJ, Walsh AL, et al. Non‐typhoidal salmonella bacteremia among HIV‐infected Malawian adults: high mortality and frequent recrudescence. AIDS 2002;16(12):1633‐41. - PubMed
Graham 2002
    1. Graham SM. Salmonellosis in children in developing and developed countries and populations. Current Opinion in Infectious Diseases 2002;15(5):507‐12. - PubMed
Hakanen 2006
    1. Hakanen AJ, Kotilainen P, Pitkanen S, Huikko S, Siitonen A, Huovinen P. Reduction in fluoroquinolone susceptibility among non‐typhoidal strains of Salmonella enterica isolated from Finnish patients. Journal of Antimicrobial Chemotherapy 2006;57(3):569‐72. - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Chapter 6 Searching for studies Highly sensitive search strategies for identifying reports of randomized controlled trials in MEDLINE [Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011]. Available from www.cochrane‐handbook.org.
Hohmann 2001
    1. Hohmann EL. Nontyphoidal salmonellosis. Clinical Infectious Disease 2001;32(2):263‐9. - PubMed
Ispahani 2000
    1. Ispahani P, Slack RC. Enteric fever and other extraintestinal salmonellosis in University Hospital Nottingham, UK, between 1980 and 1997. European Journal of Clinical Microbiology and Infectious Diseases 2000;19(9):679‐87. - PubMed
Jafari 2002
    1. Jafari M, Forsberg J, Gilcher RO, Smith JW, Crutcher JM, McDermott M, et al. Salmonella sepsis caused by a platelet transfusion from a donor with a pet snake. New England Journal of Medicine 2002;347(14):1075‐8. - PubMed
Jertborn 1990
    1. Jertborn M, Haglind P, Iwarson S, Svennerholm AM. Estimation of symptomatic and asymptomatic Salmonella infections. Scandinavian Journal of Infectious Diseases 1990;22(4):451‐5. - PubMed
Kankwatira 2004
    1. Kankwatira AM, Mwafulirwa GA, Gordon MA. Non‐typhoidal salmonella bacteraemia‐an under‐recognized feature of AIDS in African subjects. Tropical Doctor 2004;34(4):198‐200. - PubMed
Kariuki 2006
    1. Kariuki S, Revathi G, Kariuki N, Kiiru J, Mwituria J, Muyodi J, et al. Invasive multidrug‐resistant nontyphoidal Salmonella infections in Africa: zoonotic or anthroponotic transmission?. Journal of Medical Microbiology 2006;55(Pt 5):585‐91. - PubMed
Kingsley 2009
    1. Kingsley RA, Msefula CL, Thomson NR, Kariuki S, Holt KE, Gordon MA, et al. Epidemic multiple drug resistant Salmonella Typhimurium causing invasive disease in sub‐Saharan Africa have a distinct genotype. Genome Research 2009;19(12):2279‐87. - PMC - PubMed
Lin 2003
    1. Lin TY, Chiu CH, Lin PY, Wang MH, Su LH, Lin TY. Short‐term ceftriaxone therapy for treatment of severe non‐typhoidal Salmonella enterocolitis. Acta Paediatrica 2003;92(5):537‐40. - PubMed
Mason 2000
    1. Mason CJ, Longfield RN. Nontyphoidal Salmonella infections. In: Magill AJ, Laughlin LW editor(s). Hunter's Tropical Medicine and Emerging Infectious Diseases. 8th Edition. Philadelphia: W. B. Saunders, 2000:484‐90.
MDH 2007
    1. Minnesota Department of Health. Causes and symptoms of salmonellosis. www.health.state.mn.us/divs/idepc/diseases/salmonellosis/basics.html 20 November 2007 (accessed 2 April 2008).
Mead 1999
    1. Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, et al. Food‐related illness and death in the United States. Emerging Infectious Diseases 1999;5(5):607‐25. - PMC - PubMed
Molbak 2002
    1. Molbak K, Gerner‐Smidt P, Wegener HC. Increasing quinolone resistance in Salmonella enterica serotype Enteritidis. Emerging Infectious Diseases 2002;8(5):514‐5. - PMC - PubMed
Morpeth 2009
    1. Morpeth SC, Ramadhani HO, Crump JA. Invasive non‐Typhi Salmonella disease in Africa. Clinical Infectious Diseases 2009;49(4):606‐11. - PMC - PubMed
Panhotra 2004
    1. Panhotra BR, Saxena AK, Al‐Ghamdi AM. Emerging nalidixic acid and ciprofloxacin resistance in non‐typhoidalSalmonella isolated from patients having acute diarrhoeal disease. Annals of Saudi Medicine 2004;24(5):332‐6. - PMC - PubMed
Rabsch 2001
    1. Rabsch W, Tschape H, Baumler AJ. Non‐typhoidal salmonellosis: emerging problems. Microbes and Infection 2001;3(3):237‐47. - PubMed
Reese 1991
    1. Reese RE, Betts RF. Antibiotic use. In: Reese RE, Betts RF editor(s). A practical approach to Infectious diseases. 3rd Edition. Boston: Little Brown, 1991:821‐1007.
Review Manager 5 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008.
Rowe 1997
    1. Rowe B, Ward LR, Threlfall EJ. Multidrug‐resistant Salmonella typhi: a worldwide epidemic. Clinical Infectious Disease 1997;24(Suppl 1):S106‐9. - PubMed
Vallenas 1985
    1. Vallenas C, Hernandez H, Kay B, Black R, Gotuzzo E. Efficacy of bone marrow, blood, stool and duodenal contents cultures for bacteriologic confirmation of typhoid fever in children. Pediatric Infectious Diseases 1985;4(5):496‐8. - PubMed
Yee 2002
    1. Yee CL, Duffy C, Gerbino PG, Stryker S, Noel GJ. Tendon or joint disorders in children after treatment with fluoroquinolones or azithromycin. Paediateric Infectious Disease Journal 2002;21(6):525‐9. - PubMed
Zapor 2005
    1. Zapor M, Dooley DP. Salmonellosis. www.emedicine.com/med/topic2058.htm 2005 (accessed 14 September 2007).

References to other published versions of this review

Sirinavin 2000
    1. Sirinavin S, Garner P. Antibiotics for treating Salmonella gut infections. Cochrane Database of Systematic Reviews 2000, Issue 1. [DOI: 10.1002/14651858.CD001167] - DOI - PubMed

Substances

LinkOut - more resources