Treatment of Non-Typhoidal Salmonella Bacteremia

First-line Treatment Options

The Centers for Disease Control and Prevention recommends ciprofloxacin as the primary drug of choice for non-typhoidal Salmonella bacteremia in immunocompetent adults, typically administered at 500 mg twice daily for 14 days 2, 3
For severe infections or in immunocompromised patients, initial combination therapy with ceftriaxone (2 g once daily IV) plus ciprofloxacin is recommended until susceptibility results are available 1
After susceptibility testing, therapy can be de-escalated to a single appropriate agent based on results 1

Trimethoprim-sulfamethoxazole (TMP-SMZ) can be used if the organism is susceptible 4, 1
Amoxicillin (500 mg three times daily) can be used if susceptibility is confirmed 1

Immunocompromised patients require longer treatment courses (14 days or longer if relapsing) 4
Immunocompromised patients may benefit from combination therapy initially (ceftriaxone plus ciprofloxacin) 1
Long-term suppressive therapy may be needed to prevent recurrence in HIV-infected patients 3
In children, fluoroquinolones should be used with caution and only if no alternatives exist 2
In children, preferred options include TMP-SMZ, ampicillin, cefotaxime, or ceftriaxone 2
In pregnant women, fluoroquinolones should be avoided 2, 5
In pregnant women, recommended alternatives include ampicillin, cefotaxime, ceftriaxone, or TMP-SMZ 2

For patients who have experienced Salmonella bacteremia, especially those who are immunocompromised, long-term suppressive therapy with ciprofloxacin is recommended to prevent recurrence 3, 6
The typical regimen for suppressive therapy is ciprofloxacin 500 mg twice daily for at least 2 months 6

Minimum 14 days for bacteremia in immunocompetent patients 4, 2
Extended treatment (>14 days) for immunocompromised patients or those with persistent or recurrent infection 4
Secondary prophylaxis may be required for immunocompromised patients, particularly those with HIV infection 3