Treatment of salmonella with antibiotics

• Share
• Email
• Print
• Feedback

Medical Care

Salmonella gastroenteritis is usually a self-limiting disease. Fluid and electrolyte replacement may be indicated in severe cases. Because antibiotics do not appear to shorten the duration of symptoms and may actually prolong the duration of convalescent carriage, they are not routinely used to treat uncomplicated nontyphoidal Salmonella gastroenteritis. Current recommendations are that antibiotics be reserved for patients with severe disease or patients who are at a high risk for invasive disease .

Historically, recommended regimens for the treatment of typhoid fever included ampicillin, trimethoprim-sulfamethoxazole, or chloramphenicol. Emerging drug resistance over the past 20 years has limited the usefulness of these antibiotics. Presently, quinolone, macrolide, and third-generation cephalosporin antibiotics are preferred for empiric therapy pending sensitivities. Unfortunately, sensitivity to quinolones has been steadily declining, and these are no longer fool-proof agents for typhoid fever. A growing rate of resistance of nontyphoidal salmonella to nalidixic acid and ceftriaxone has been reported. [36]

Clinical data suggested reduced effectiveness of quinolone therapy in patients with nalidixic acid-resistant Salmonella strains. [37] A study of more than 1000 stored Salmonella isolates from Finland has confirmed earlier data that showed that resistance to nalidixic acid by means of disk diffusion is a sensitive and specific method of screening Salmonella isolates for reduced susceptibility to fluoroquinolones. [38]

Although uncommon in the United States, resistance to quinolone antibiotics among typhoidal and nontyphoidal salmonellae is increasingly common elsewhere. In one 22-year surveillance study in Spain, the prevalence of nalidixic acid resistance increased almost 80-fold to 38.5%.

In a review of US data from the National Antimicrobial Resistance Monitoring System, 58% of S typhimurium isolates isolated between 1997 and 1998 were resistant to at least one antibiotic, and 3 multidrug-resistant strains (resistant to ≥5 antibiotics) accounted for 74% of isolates.

The decline in prevalence of chloramphenicol resistance in many endemic areas has led to reconsideration of its use as an alternative to newer-generation fluoroquinolones or azithromycin.

There are widespread concerns about aplastic anemia with chloramphenicol and dysglycemia with gatifloxacin. In most developed settings, there are also cautions or specific constraints about the use of fluoroquinolones in children and pregnant or nursing mothers, because of potential cartilage toxicities; other adverse effects such as photosensitivity, electrocardiographic abnormalities, and tendinopathies largely affect elderly patients with concomitant problems such as renal impairment. [39]

Azithromycin is likely to be the preferred empirical treatment, often given together with ceftriaxone, in developed countries where chloramphenicol is usually reserved for life-threatening situations, for which no alternatives are available, and physicians are reluctant to use fluoroquinolones in children and lack easy access to gatifloxacin. [39]

In an endemic area such as Nepal, gatifloxacin is as effective as chloramphenicol in ambulatory young patients, and adherence to treatment is improved by the shorter duration and smaller number of tablets in the gatifloxacin regimen. [39]

Salmonella bacteremia is generally treated with a single bactericidal drug for 10-14 days. Given the resistance trends, life-threatening infections should be treated with both a third-generation cephalosporin and a fluoroquinolone until the susceptibilities of antimicrobial agents are known. [2]

If endocarditis or infectious arteritis is documented, urgent surgical treatment is usually necessary. Antimicrobial therapy for endovascular infections should be continued for a minimum of 6 weeks after successful surgery.

Years of therapy might be needed when surgery is not possible (eg, retained prosthetic devices, chronic bone and joint infections). [2]

For proven or possible CNS involvement, high-dose ceftriaxone would be the best choice for optimal penetration of the blood-brain barrier. [2]

Treatment of salmonella infection in pregnancy is controversial, and antibiotic therapy should be reserved for cases of invasive disease, using amoxicillin or cephalosporin. [40] Case reports describe of fetal loss in the setting of disseminated Salmonella infection. [41, 40]

Jenny Lelwica Buttaccio, OTR/L, is a licensed occupational therapist and advocate for patients with Lyme disease.

Andy Miller, MD, is board-certified in internal medicine and infectious disease. He is an associate professor at Weill Cornell Medicine in New York City.

As you cope with the signs and symptoms associated with a salmonella infection, determining your best treatment options is key to a prompt and successful recovery. Whether or not you’ll require treatment for salmonella depends on a variety of factors, including the severity of the condition, how long you’ve had it, and if you’re experiencing dehydration.

Let’s take a look at the available treatment options for salmonella.

Home Remedies and Lifestyle

Stay Hydrated

Since salmonella infections can cause vomiting and diarrhea, it’s important to stay hydrated as best you can.   If you’re an adult, increase your fluid intake of water, broths, sports drinks, caffeine-free drinks, or fruit juices.

If your nausea is substantial, you may find that beverages are difficult to drink. In this case, try sucking on ice chips throughout the day, which you may find is a more tolerable way to rehydrate.

For children who experience mild to modern dehydration, an oral solution such as Pedialyte, aimed at rehydrating the child, can be useful in restoring the lost nutrients and electrolytes. Furthermore, if the child is unwell but not exhibiting signs of dehydration, increase their fluid intake more frequently.

When you lose more fluid than you consume, dehydration can creep up on you. The signs of dehydration may vary from one person to another and fluctuate with age. In adults, consider the following as signs of dehydration:

• Excessive thirst
• Decreased urinary frequency or output
• Darker than normal urine color
• Dizziness
• Episodes of confusion
• Extreme fatigue

Children may show the signs of dehydration differently. They include:

• Dry mouth
• Dry or sticky tongue
• An absence of tears when the child cries
• Sunken cheeks or the soft spot on the top of the child’s head
• Frequency of urination decreases
• Diapers remain dry for three hours or more
• Lethargy
• Increased irritability or crying more often

Seek advice from your healthcare provider if you or a child is displaying signs of dehydration or are unable to keep fluids down.

Eat Mild Foods

Certain foods have been known to worsen salmonella symptoms like diarrhea, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The foods to avoid include:  

• Alcoholic drinks
• Caffeinated beverages
• Dairy products
• Fried or greasy foods
• Sugary drinks
• Fruits like apples, peaches, or pears
• Spicy foods
• Drinks containing artificial sweeteners

When you feel like your stomach is up to handling some food, a mild, bland diet might be your best bet. You’ve probably heard of the BRAT diet, which stands for bananas, rice, applesauce, and toast. Although research doesn’t indicate that this diet is better or more helpful than other ones, for some people the BRAT diet can be a non-irritating way to reintroduce food to a delicate digestive tract.

Eat small meals whenever your symptoms allow and continue to drink replenishing fluids.

Try a Heating Pad

For some people, a heating pad on a low setting my ease abdominal cramping. However, it may not be comfortable for all who have vomiting and diarrhea due to salmonella. If you try it, and it doesn’t help you, stop using it—you won’t recover more quickly by pushing through something that’s uncomfortable to you.

Rest

Many people recover from salmonella infection with a combination of rest and maintaining adequate fluid intake. Try to lighten your load and get plenty of rest until symptoms subside so that your body can heal.

Over-the-Counter Therapies

Pain medications

Over-the-counter painkillers, like ibuprofen, may be useful to reduce body aches and pains and lessen symptoms.

Antidiarrheals

In some cases, antidiarrheal medications, like Immodium, might decrease the abdominal discomfort associated with salmonella. But this type of medication has some drawbacks, according to the Mayo Clinic. Antidiarrheals may extend the length of time you experience diarrhea from the infection.  

Probiotics

In 2013, a team of microbiologists from the University of California, Irvine found that a probiotic strain originally used to treat the symptoms of irritable bowel may soothe gut infections caused by salmonella.   The probiotic known to be helpful is a strain of E. coli called Nissle 1917. Researchers indicated this probiotic strain was only available in Germany. However, 2018 findings suggest this beneficial bacteria can be found in the U.S. market as well—though availability of it is limited.

If you’re interested in the use of probiotics, consult with your doctor to find one that might be right for you.

Prescriptions

Typically, people recover from salmonella without medical intervention in a four to seven-day timeframe. In uncomplicated cases of the infection, antibiotics aren’t recommended.

But if your infection persists, you have a compromised immune system, or the infection has entered your bloodstream, your doctor may prescribe a course of antibiotics for you.   Some of the antibiotics used to treat the infection include amoxicillin, cefotaxime, and ciprofloxacin, to name a few.

However, antibiotic treatment poses some risks, including an increased possibility of a relapse. Also, the antibiotics may extend the amount of time you carry the bacteria and prolong the stage where you can infect others with salmonella.

Additionally, if you’re dealing with severe dehydration or have been ill for longer than seven days, you may require hospitalization. In the hospital, you may receive intravenous (IV) fluids or antibiotics to overcome the infection.

Specialist-Driven Procedures

In most cases of salmonella, surgery isn’t required to recover from the infection. In fact, many people will get well with a mix of home treatments and lifestyle modifications. However, if you experience a high fever, blood in your stool or signs of dehydration, consult with your doctor. If necessary, they will recommend additional specialists or procedures.

Complementary Medicine (CAM)

Because infections like salmonella can become antibiotic-resistant, there’s a need to conduct studies in the complementary alternative medicine realm of healthcare. But to date, no research has been conducted on humans in this medical subset.

• Share
• Email
• Print
• Feedback

Medical Care

Aspects of treatment in Salmonella infection include the following:

For uncomplicated gastroenteritis caused by nontyphoidal Salmonella species, antimicrobial therapy is not indicated because it does not shorten the duration of illness and may prolong the duration of fecal excretion.

Treatment involves monitoring hydration status and intravenous (IV) therapy to correct electrolyte imbalance or restore intravascular volume.

Antidiarrheal agents may actually prolong GI transit time and the illness.

Antimicrobial agents and hospital admission may be recommended in Salmonella gastroenteritis in infants younger than 3 months, infants younger than 12 months with temperatures of more than 39°C and unknown blood culture results, and patients with hemoglobinopathies, human immunodeficiency virus (HIV) infection or other causes of immunosuppression, neoplasms, or chronic GI illnesses.

The recommended antibiotics for individuals at high risk for invasive disease include ampicillin, amoxicillin, and trimethoprim-sulfamethoxazole (TMP-SMZ). In areas with multidrug resistance, cefotaxime or ceftriaxone are recommended.

Treatment of invasive Salmonella disease (bacteremia, extraintestinal manifestations)

Empiric antimicrobial therapy should include a broad-spectrum cephalosporin (cefotaxime or ceftriaxone). Once susceptibilities are available, narrower-spectrum therapy includes ampicillin, amoxicillin, as well as broader-spectrum agents such as chloramphenicol, TMP-SMZ, or a fluoroquinolone.

A 14-day course of antibiotics is recommended for patients with bacteremia.

Patients with localized infection, such as osteomyelitis or an abscess, or patients with bacteremia and HIV infections should receive 4-6 weeks of therapy.

For Salmonella meningitis, ceftriaxone or cefotaxime is recommended for 4 weeks or longer.

Enteric fever caused by S. typhi infection

For S. typhi infection, initial empiric therapy with ceftriaxone is recommended due to widespread resistance. If susceptible, chloramphenicol, ampicillin, or TMP-SMZ may be used. Duration of therapy should be 14 days.

In severe infection, parenteral therapy is indicated.

Use antipyretics with caution or not at all because they may cause precipitous drops in temperature and shock. Fever may last 5-7 days, even with appropriate therapy.

Relapse is common (≤ 15%), and patients must be re-treated.

A short course of high dose-corticosteroids may be involved in treatment of patients with life-threatening neurologic complications of enteric fever.

High-dose ampicillin or high-dose amoxicillin plus probenecid for 4-6 weeks has cured many chronic carriers. Ciprofloxacin is the drug of choice for adult carriers. [5]

As many as 40% of nontyphoidal Salmonella (NTS) isolates in the United States are multidrug resistant, with increasing resistance to all Salmonella strains worldwide. [7] In particular parts of the world (ie, India, Pakistan, Egypt), multiply antibiotic-resistant strains of S. typhi are reported. Travelers from these regions should be treated with a 7-day to 10-day course of ceftriaxone or 5-day to 7-day course of ciprofloxacin or ofloxacin.

Decreased ciprofloxacin susceptibility and ceftriaxone resistance has been reported in developing countries. [31, 32, 33, 34]

Surgical Care

Cholecystectomy may be curative in carriers with chronic gallbladder disease. Focal abscesses may require drainage. [7]

Consultations

Consider consultation with a pediatric infectious disease specialist if the appropriate antibiotic for treatment or the length of treatment are questioned in patients with documented Salmonella infection. Consider surgical consultation for patients with enteric fever who appear to have complications such as intestinal perforation, splenic rupture, or pancreatitis.

Restrict initial oral intake to electrolyte solutions, such as Pedialyte or clear liquids. Add solid foods only when the diarrhea appears to be improving and dehydration is not present. Initially, children can be started on a BRAT diet (ie, bananas, rice, applesauce, toast) and then slowly advanced to a regular diet as tolerated.

Chen HM, Wang Y, Su LH, Chiu CH. Nontyphoid salmonella infection: microbiology, clinical features, and antimicrobial therapy. Pediatr Neonatol. 2013 Jun. 54(3):147-52. [Medline].

Fleisher GR, Sieff CA. Infectious Disease Emergencies. Fleisher, GR, Ludwig, SL. Textbook of Pediatric Emergency Medicine. 6th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2010. Ch. 92.

Bhutta ZA. Salmonella. Kliegman RM, Stanton B, St. Geme J, et al. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011. 948-59/Ch. 190.

Schneider L, Ehlinger M, Stanchina C, Giacomelli MC, Gicquel P, Karger C, et al. Salmonella enterica subsp. arizonae bone and joints sepsis. A case report and literature review. Orthop Traumatol Surg Res. 2009 May. 95(3):237-42. [Medline].

Brady MT, et al. Salmonella infections. Pickering L. Red Book: Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. 635-41.

Chiu CH, Chuang CH, Chiu S, et al. Salmonella enterica serotype Choleraesuis infections in pediatric patients. Pediatrics. 2006 Jun. 117(6):e1193-6. [Medline].

Reller ME. Salmonella Species. Long A, Pickering, L, Prober C (Editors). Principles and Practices of Pediatric Infectious Diseases Elsevier, Inc. 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2012. 814-819.

CDC. Vital signs: incidence and trends of infection with pathogens transmitted commonly through food--foodborne diseases active surveillance network, 10 U.S. sites, 1996-2010. MMWR Morb Mortal Wkly Rep. 2011 Jun 10. 60(22):749-55. [Medline].

Sánchez-Vargas FM, Abu-El-Haija MA, Gómez-Duarte OG. Salmonella infections: an update on epidemiology, management, and prevention. Travel Med Infect Dis. 2011 Nov. 9(6):263-77. [Medline].

Miller MA, Sentz J, Rabaa MA, et al. Global epidemiology of infections due to Shigella, Salmonella serotype Typhi, and enterotoxigenic Escherichia coli. Epidemiol Infect. 2008 Apr. 136(4):433-5. [Medline].

CDC. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food - 10 states, 2009. MMWR Morb Mortal Wkly Rep. 2010 Apr 16. 59(14):418-22. [Medline].

Walters MS, Simmons L, Anderson TC, et al. Outbreaks of Salmonellosis From Small Turtles. Pediatrics. 2016 Jan. 137 (1):[Medline].

Tsai MH, Huang YC, Chiu CH, et al. Nontyphoidal Salmonella bacteremia in previously healthy children: analysis of 199 episodes. Pediatr Infect Dis J. 2007 Oct. 26(10):909-13. [Medline].

Boggild AK, Castelli F, Gautret P, et al. Vaccine preventable diseases in returned international travelers: results from the GeoSentinel Surveillance Network. Vaccine. 2010 Oct 28. 28(46):7389-95. [Medline].

Johnson KJ. Crossing borders: one world, global health: CDC updates recommendations for typhoid vaccination. Clin Infect Dis. 2012 Apr. 54(7):v-vi. [Medline].

Johnson KJ, Gallagher NM, Mintz ED, et al. From the CDC: new country-specific recommendations for pre-travel typhoid vaccination. J Travel Med. 2011 Nov-Dec. 18(6):430-3. [Medline].

Galanakis E, Bitsori M, Maraki S, et al. Invasive non-typhoidal salmonellosis in immunocompetent infants and children. Int J Infect Dis. 2007 Jan. 11(1):36-9. [Medline].

Shkalim V, Amir A, Samra Z, Amir J. Characteristics of non-typhi Salmonella gastroenteritis associated with bacteremia in infants and young children. Infection. 2012 Jun. 40(3):285-9. [Medline].

Jones TF, Ingram LA, Cieslak PR, et al. Salmonellosis outcomes differ substantially by serotype. J Infect Dis. 2008 Jul 1. 198(1):109-14. [Medline].

CDC. Trends in incidence of frequently identified non-typhoidal Salmonella serotypes. FoodNet News. 2008. 2(3):

Centers for Disease Control and Prevention. Outbreak of multidrug-resistant Salmonella enterica serotype Newport infections associated with consumption of unpasteurized Mexican-style aged cheese--Illinois, March 2006-April 2007. MMWR Morb Mortal Wkly Rep. 2008 Apr 25. 57(16):432-5. [Medline].

CDC. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--10 states, 2006. MMWR Morb Mortal Wkly Rep. 2007 Apr 13. 56(14):336-9. [Medline].

CDC. Multistate outbreak of human Salmonella infections caused by contaminated dry dog food--United States, 2006-2007. MMWR Morb Mortal Wkly Rep. 2008 May 16. 57(19):521-4. [Medline].

CDC. Multistate outbreak of human Salmonella infections associated with exposure to turtles--United States, 2007-2008. MMWR Morb Mortal Wkly Rep. 2008 Jan 25. 57(3):69-72. [Medline].

CDC. Salmonella Litchfield outbreak associated with a hotel restaurant--Atlantic City, New Jersey, 2007. MMWR Morb Mortal Wkly Rep. 2008 Jul 18. 57(28):775-9. [Medline].

CDC. Salmonella typhimurium infection associated with raw milk and cheese consumption--Pennsylvania, 2007. MMWR Morb Mortal Wkly Rep. 2007 Nov 9. 56(44):1161-4. [Medline].

Nguyen TQ, Reddy V, Sahl S, et al. Importance of Travel in Domestically Acquired Typhoid Fever Infections: Opportunities for Prevention and Early Detection. J Immigr Minor Health. 2008 May 29. [Medline].

Gupta SK, Medalla F, Omondi MW, et al. Laboratory-based surveillance of paratyphoid fever in the United States: travel and antimicrobial resistance. Clin Infect Dis. 2008 Jun 1. 46(11):1656-63. [Medline].

Ochiai RL, Acosta CJ, Danovaro-Holliday MC, et al. A study of typhoid fever in five Asian countries: disease burden and implications for controls. Bull World Health Organ. 2008 Apr. 86(4):260-8. [Medline]. [Full Text].

Gradel KO, Dethlefsen C, Ejlertsen T, et al. Increased prescription rate of antibiotics prior to non-typhoid Salmonella infections: a one-year nested case-control study. Scand J Infect Dis. 2008. 40(8):635-41. [Medline].

Rahman M, Siddique AK, Shoma S, et al. Emergence of multidrug-resistant Salmonella enterica serotype Typhi with decreased ciprofloxacin susceptibility in Bangladesh. Epidemiol Infect. 2006 Apr. 134(2):433-8. [Medline].

Gordon MA, Graham SM, Walsh AL, et al. Epidemics of invasive Salmonella enterica serovar enteritidis and S. enterica Serovar typhimurium infection associated with multidrug resistance among adults and children in Malawi. Clin Infect Dis. 2008 Apr 1. 46(7):963-9. [Medline].

Egorova S, Timinouni M, Demartin M, et al. Ceftriaxone-resistant salmonella enterica serotype Newport, France. Emerg Infect Dis. 2008 Jun. 14(6):954-7. [Medline].

Crump JA, Medalla FM, Joyce KW, et al. Antimicrobial resistance among invasive nontyphoidal Salmonella enterica isolates in the United States: National Antimicrobial Resistance Monitoring System, 1996 to 2007. Antimicrob Agents Chemother. 2011 Mar. 55(3):1148-54. [Medline].

Saps M, Pensabene L, Di Martino L, et al. Post-infectious functional gastrointestinal disorders in children. J Pediatr. 2008 Jun. 152(6):812-6, 816.e1. [Medline].

[Guideline] National Institute for Health and Clinical Excellence (NICE). National Collaborating Centre for Women's and Children's Health. Diarrhoea and vomiting in children. Diarrhoea and vomiting caused by gastroenteritis: diagnosis, assessment and management in children younger than 5 years. Apr 2009.

Younus M, Wilkins MJ, Davies HD, et al. Case-control study of disease determinants for non-typhoidal Salmonella infections among Michigan children. BMC Res Notes. 2010 Apr 16. 3(1):105. [Medline].

Gradel KO, Dethlefsen C, Schonheyder HC, et al. Magnitude of bacteraemia is associated with increased mortality in non-typhoid salmonellosis: a one-year follow-up study. APMIS. 2008 Feb. 116(2):147-53. [Medline].

Salmonella infection is one of many possible causes of gastroenteritis (also known as ‘gastro’). There are thousands of different types of Salmonella bacteria and they occur in many domestic and wild animals, including birds, sometimes causing illness in them. Two specific types of Salmonella can cause typhoid and paratyphoid fever, which causes a different illness to that described below. Typhoid and paratyphoid infections can be serious and are not common in Australia.

Salmonella infection is a notifiable condition 1

How Salmonella is spread

Salmonella infection usually results from ingestion of the bacteria from contaminated food, water or hands. Eggs, milk, meat or poultry are particularly high risk foods. Fruit and vegetables may also be contaminated, especially if manure has been used as fertiliser.

People may become infected if they transfer animal faeces containing Salmonella bacteria from their hands to their mouths, for example, if eating after touching animals and failing to wash their hands.

Person-to-person spread may occur when hands, objects or food become contaminated with faeces from people who are infected and the bacteria are then taken in by mouth by another person.

Signs and symptoms

Symptoms may include:

• fever
• diarrhoea
• loss of appetite
• headache
• stomach cramps
• nausea and vomiting.

Sometimes there may be blood or mucus in the faeces. Dehydration is a serious complication. The illness may be particularly severe in young children, the elderly and people with immune suppression.

A small percentage of people may develop arthritis after having a Salmonella infection.

Diagnosis

Diagnosis is made by growing Salmonella bacteria from a faecal specimen or by detecting Salmonella in a faecal sample using a PCR (polymerase chain reaction) test in a pathology laboratory.

Incubation period

(time between becoming infected and developing symptoms)

6 to 72 hours, usually 12 to 36 hours.

Infectious period

(time during which an infected person can infect others)

The faeces are always infectious when symptoms are present. Some people continue to carry Salmonella bacteria in the bowel and shed them in the faeces for months after recovering.

Treatment

Recovery from Salmonella infection usually occurs within a week and antibiotic treatment is not normally required. However, a doctor may prescribe antibiotics for young infants, the elderly and in some other situations. See also Typhoid and paratyphoid.

Gastroenteritis is a common illness, which can be particularly serious in young children.

The following are general recommendations for the treatment of gastroenteritis:

• Give plenty of fluids. Oral rehydration solution is highly recommended for children with mild to moderate dehydration. It is available at pharmacies and should be administered following the instructions on the packaging.
• Mildly unwell children should be given their usual fluids more often. Carbonated (fizzy) drinks or undiluted juice should be avoided.
• Medicines to prevent vomiting or diarrhoea should not be given (especially in children), except where specifically advised by a doctor.
• Breastfed babies should continue to be breastfed throughout their illness.
• Children on formula or solid diets should restart their normal diet (including full strength lactose containing milk) following rehydration with oral rehydration solution.
• Children who are hungry or ask for food should be given small portions of their usual foods, but avoid foods high in sugar or fat.

Seek medical advice if any of the following symptoms occur:

• Signs of dehydration, such as thirst and decreased urination, lethargy, dry mouth, feeling faint on standing
• fever
• severe abdominal pain
• bloody diarrhoea.

• Signs of dehydration, such as thirst and decreased urination, lethargy, dry mouth, sunken eyes, feeling faint on standing
• fever
• abdominal pain
• bloody diarrhoea
• any symptoms in a child less than 12 months of age.

Prevention

• Exclude people with Salmonella infection from childcare, preschool, school and work until there has been no diarrhoea for 24 hours. If working as a food handler in a food business, the exclusion period should be until there has been no diarrhoea or vomiting for 48 hours.
• Infants, children and adults with Salmonella infection should not swim until there has been no diarrhoea for 24 hours.
• Cook meat thoroughly, until the juices run clear.
• Do not purchase dirty or cracked eggs.
• Strict food handling procedures should be used when preparing dishes containing raw or incompletely cooked eggs, such as homemade ice cream and mayonnaise.
• Do not consume unpasteurised milk.
• Follow good food handling procedures.
• Follow good hand washing and keeping areas clean procedures.
• Recognise the risk of Salmonella infections in pets. Chickens, ducklings, tropical freshwater fish and turtles are particularly risky for small children.
• Hand washing after handling raw meat, (especially chicken) or raw eggs
• Always wash fruit (including melons) and vegetables before eating. If home grown, wash them before bringing them into the house.
• Infected people who no longer have symptoms should take special care with hand washing if they are involved in food preparation or in caring for patients in hospital, the elderly or children.
• Babies and small children without diarrhoea who are not toilet trained should wear tight fitting waterproof pants or swimming nappies in swimming pools and changed regularly in the change room. When faecal accidents occur, swimming pools should be properly disinfected.

Useful links

1 – In South Australia the law requires doctors and laboratories to report some infections or diseases to SA Health. These infections or diseases are commonly referred to as 'notifiable conditions'.