Educational Pearl
Kentucky Antimicrobial
Stewardship Innovation
Consortium
Don’t Let the Bug Beat You: Salmonella spp.
Salmonella spp. is typically contracted via consumption of contaminated food or water, particularly in endemic areas. The most
common acute presentation is gastrointestinal illness (cramping, diarrhea, vomiting) and fever. It may cause more severe disease,
including sepsis, rash, prolonged or bloody diarrhea, bacteremia, or other extraintestinal infection.1-4 Molecular testing for
gastrointestinal pathogens are becoming increasingly common in clinical practice. When a stool specimen tests positive for
Salmonella spp., how should they be evaluated and managed?
What guidance is available?
Treatment approach differs based species. Key differentiator is if Salmonella enterica, or typhoid/paratyphoid disease (also called
Typhoid fever) is identified vs. other Salmonella spp., or non-typhoidal disease. The Centers for Disease Control and Infectious
Diseases Society of America both address salmonellosis management. 2-4
Table 1: Salmonella spp. Infections2-6
Non-typhoidal Disease Salmonella enterica / Typhoid fever
Epidemiology in ~6000 annually
~250,000 annually
United States Estimated 85% of patients have travel exposure
Incubation Period 12 hours – 6 days 6 – 30 days
Duration of 7 – 30 days
1 – 7 days
Symptoms Relapse occurs in up to 10% of patients after recovery
Mostly self-limiting; treatment ONLY
recommended in:
• Infants
Treatment RECOMMENDED to reduce risk of
Decision to Treat • Age > 50 years
complications
• Immunocompromised (e.g. HIV, receiving
chemotherapy)
• Severe disease
Primarily based on susceptibility; consider area of travel
First line: 3rd generation cephalosporin,
when selecting empiric therapy
Antibiotic Therapy fluoroquinolones
First line for FQ susceptible isolates: ciprofloxacin
Alternative: azithromycin
Alternatives: azithromycin, ceftriaxone, carbapenems
Supportive Therapy Rehydration Rehydration
• Hand hygiene
• Hand hygiene
Prevention • Food safety
• Food safety
• Vaccine available
Key Takeaway: Non-typhoidal Salmonella spp. infections, which are far more common in the United States, are often
self-limiting and only require antibiotic therapy in high-risk patients or severe disease. Salmonella enterica infections,
also known as typhoid or paratyphoid disease should be managed with antibiotics.
References:
1. Salmonella (Salmonellosis). Food and Drug Administration. Updated Mar 29, 2019. Accessed May 21, 2025. Available at: https://www.fda.gov/food/foodborne-
pathogens/salmonella-salmonellosis
2. Connor BA and Leung DT. “Post-Travel Diarrhea.” CDC Yellow Book. Ed. 2026. Available at: https://www.cdc.gov/yellow-book/hcp/post-travel-evaluation/post-
travel-diarrhea.html
3. Watkinds LKF, Shih DC and Dorough L. “Thyphoid and parathyphoid Fever. CDC Yellow Book. Ed. 2026. Available at: https://www.cdc.gov/yellow-book/hcp/travel-
associated-infections-diseases/typhoid-and-paratyphoid-fever.html
4. Shane AL, Mody RK and Crump JA et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious
Diarrhea. Clin Infect Dis. 2017;65(12):e45-80.
5. CDC. COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2022.
6. Gilbert DN, Chanbers HF, Eliopoulos GM et al. The Sanford Guide to Antimicrobial Chemotherapy. 50th addition. Sperryville, VA. Copyright 2019.
Created 6.4.25
