Anbx in Nontyphoidal Salmonella gastroenteritis

 Q: All of the following are the indications for antimicrobial therapy in nontyphoidal Salmonella gastroenteritis EXCEPT? 

A) Severe diarrhea 

B) High or persistent fever 

C) Need for hospitalization 

D) Blood-stained diarrhea 

Answer: D

Antimicrobial therapy is usually not recommended for nontyphoidal salmonella gastroenteritis. This increases the risk for asymptomatic Salmonella carriage without any benefit. Antimicrobials should be used only if diarrhea is severe (> 10 stools per day), fever is either high or persistent, or there is a need for hospitalization. 

The blood in the stool is not an indication for antimicrobial in nontyphoidal salmonella gastroenteritis. Moreover, salmonella gastroenteritis is rarely marked by overt blood in the stool. It should raise the suspicion of Shigella or enterohemorrhagic E. coli.

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References:

1. Onwuezobe IA, Oshun PO, Odigwe CC. Antimicrobials for treating symptomatic non-typhoidal Salmonella infection. Cochrane Database Syst Rev 2012; 11:CD001167. 

2. Hung YT, Lay CJ, Wang CL, Koo M. Characteristics of nontyphoidal Salmonella gastroenteritis in Taiwanese children: A 9-year period retrospective medical record review. J Infect Public Health. 2017 Sep-Oct;10(5):518-521. doi: 10.1016/j.jiph.2016.09.018. Epub 2017 Feb 13. PMID: 28209468.