Modification and duration of intravenous therapy for nontyphoidal Salmonella enteritis

The duration of intravenous therapy for nontyphoidal Salmonella enteritis depends on the site of infection – seek expert advice. For patients without complications, a switch to oral therapy may be appropriate when the patient becomes afebrile. For patients with complications (eg bacteraemia, endovascular infection, meningitis, osteoarticular infection) and children younger than 3 months, it may be appropriate to use intravenous therapy for the duration of treatment.

Pharmacokinetics may be altered in patients who are critically ill (eg because of enhanced kidney clearance or changes in volume of distribution). To ensure adequate drug exposure in patients with nontyphoidal Salmonella enteritis who have septic shock or require intensive care support, modified dosages of ceftriaxone and ciprofloxacin are recommended. Once the critical illness has resolved, consider switching to the standard dosage. If the isolate is not reported to have dose-dependent susceptibility to these drugs (ie susceptible dose dependent [SDD] or susceptible increased exposure [I or SIE]), it may also be appropriate to switch to the standard dose – seek expert advice.

The duration of therapy for nontyphoidal Salmonella enteritis in patients with immune compromise has not been well studied. In patients with immune compromise (eg advanced HIV, solid organ or bone marrow transplant recipients) who are at risk of complicated disease, a longer duration of therapy may be considered – seek expert advice.