Antimicrobial therapy of salmonelloses--current state and perspectives

Salmonellosis in humans is most often manifested as a self-limiting gastroenteritis. Antimicrobial therapy is superfluous in the milder forms of the disease and in Salmonella carriage but can be life saving for patients with septic salmonellosis and patients at risk of extraintestinal dissemination of the infection. The therapeutic approach is based on the clinical course of the disease and the patient's immune reactivity. Antimicrobial therapy is usually initiated before the in vitro susceptibility tests of the isolate become available. Currently, the drugs of choice for empiric treatment of acute infectious diarrhea, in which Salmonella spp are etiologically implicated, are fluoroquinolones in adults and third generation cephalosporins in children. Alternative treatment may use azithromycin and imipenem in life-threatening systemic Salmonella infections. Aminoglycosides are considered ineffective in gastrointestinal salmonelloses. The emerging resistance to fluoroquinolones, production of extended-spectrum beta-lactamases, and the increase of multidrug resistant Salmonella strains are major problems in the search for efficient antimicrobial therapy of Salmonella infection.