Antimicrobials for treating symptomatic non-typhoidal Salmonella infection
Abstract
Background
Non-typhoidal Salmonella (NTS) commonly causes diarrhoea, and is
usually self-limiting, although sometimes people become ill with sepsis
and dehydration. Routine antibiotic use for this infection could result
in persistent colonization and the spread of resistant bacterial
strains.
Objectives
To assess the efficacy and safety of giving antibiotics to people with
NTS diarrhoea.
Search methods
We searched the Cochrane Infectious Diseases Group trials register (up
to August 2012), the Cochrane Controlled Trials Register (CENTRAL)
published in The Cochrane Library (up to Issue 8 2012); and MEDLINE,
African Index Medicus, CINAHL, EMBASE, LILACS, and the Science Citation
Index, all up to 6 August 2012. We also searched the metaRegister of
Controlled Trials (mRCT) for both completed and on going trials and
reference lists of relevant articles.
Selection criteria
Randomized controlled trials (RCTs) comparing any antibiotic treatment
for diarrhoea caused by NTS species with placebo or no antibiotic
treatment. We selected trials that included people of all ages who were
symptomatic for NTS infection. Examples of symptoms included fever,
abdominal pain, vomiting and diarrhoea. We excluded trials where the
outcomes were not reported separately for the NTS subgroup of patients.
Two review authors independently applied eligibility criteria prior to
study inclusion.
Data collection and analysis
Two review authors independently extracted data on pre-specified
outcomes and independently assessed the risk of bias of included
studies. The primary outcome was the presence of diarrhoea between two
to four days after treatment. The quality of evidence was assessed using
the GRADE methods.
Main results
Twelve trials involving 767 participants were included. No differences
were detected between the antibiotic and placebo/no treatment arms for
people with diarrhoea at two to four days after treatment (risk ratio
(RR) 1.75, 95% confidence interval (CI) 0.42 to 7.21; one trial, 46
participants; very low quality evidence). No difference was detected for
the presence of diarrhoea at five to seven days after treatment (RR
0.83, 95% CI 0.62 to 1.12; two trials, 192 participants; very low
quality evidence), clinical failure (RR 0.88, 95% CI 0.62 to 1.25; seven
trials, 440 participants; very low quality evidence). The mean
difference for diarrhoea was 0 days (95% CI -0.54 to 0.54; 202
participants, four studies; low quality evidence);for fever was 0.27
days (95% CI -0.11 to 0.65; 107 participants, two studies; very low
quality evidence); and for duration of illness was 0 days (95% CI -0.68
to 0.68; 116 participants, two studies; very low quality evidence).
Quinolone antibiotic treatment resulted in a significantly higher number
of negative stool cultures for NTS during the first week of treatment
(microbiological failure: RR 0.33, 95% CI 0.20 to 0.56; 166
participants, four trials).
Antibiotic treatment meant passage of the same Salmonella serovar one month after treatment was almost twice as likely (RR 1.96, 95% CI 1.29 to 2.98; 112 participants, three trials), which was statistically significant. Non-severe adverse drug reactions were more common among the patients who received antibiotic treatment.
Authors' conclusions
There is no evidence of benefit for antibiotics in NTS diarrhoea in
otherwise healthy people. We are uncertain of the effects in very young
people, very old people, and in people with severe and extraintestinal
disease. A slightly higher number of adverse events were noted in people
who received antibiotic treatment for NTS.
Plain Language Summary
Non-typhoidal Salmonella (NTS) can cause diarrhoea in people. In this
review, we investigated the benefits and safety of antibiotics for
treatment of NTS versus placebo or no antibiotic treatment. We found
that in otherwise healthy people, treatment with antibiotics did not
have any benefit over treatment with no antibiotics. Furthermore,
treatment with antibiotics made it more likely that patients would
continue to excrete the same organisms for up to one month after
treatment. We are unable to comment on the use of antibiotics in very
young people, very old people and people who are unable to fight off
infection because the trials we identified did not include these
patients.
Citation
Onwuezobe, I.A.; Oshun, P.O.; Odigwe, C.C. Antimicrobials for treating symptomatic non-typhoidal Salmonella infection. Cochrane Database of Systematic Reviews (2012) (Issue 11) Art. No.: CD001167. [DOI: 10.1002/14651858.CD001167.pub2]
Links
Antimicrobials for treating symptomatic non-typhoidal Salmonella infection