- Primary pathogens (Salmonella enterica (non-typhoidal serovars) · S. Typhimurium · S. Enteritidis · other nontyphoidal serotypes)
- Clinical context (Usually self-limited gastroenteritis in immunocompetent children · bacteremia and focal infection in infants <3 months, immunocompromised hosts, and sickle cell disease)
First-line therapy
Azithromycin • p.o. • 10–10 mg/kg/day • 1×/day
Max 500 mg/day · Duration: 5–7 days · Only when antibiotic therapy is indicated — preferred oral agent for at-risk outpatients tolerating oral intake
Enter weight on Kids to calculate doses
Ceftriaxone • i.v. • 50–75 mg/kg/day • 1×/day
Max 2000 mg/day · Duration: 7–10 days · Bacteremia or invasive disease — step down to oral therapy when clinically stable and susceptibilities known
- • Ceftriaxone: bacteremia, suspected or proven invasive disease, infants <3 months, severe or toxic illness, vomiting or inability to take oral therapy, hospitalized children — obtain blood cultures before antibiotics when feasible (AAP, CDC, StatPearls).
- • Trimethoprim/sulfamethoxazole: oral alternative when isolate is susceptible and child can take oral therapy — not for infants <2 months (sulfa contraindication); rising resistance limits empiric use (AAP, ESPID).
- • Step down i.v. → oral azithromycin or TMP/SMX after clinical improvement and negative blood cultures when susceptibilities allow — total course typically 7–10 days (CPS, AAP).
- • Fluoroquinolones (e.g. ciprofloxacin): only if susceptible on culture and macrolides/cephalosporins unsuitable — off-label in children; reserve for MDR isolates per ID consultation (CDC).
- • Focal infections (meningitis, osteomyelitis, endovascular): extend duration (e.g. 4–6 weeks for osteomyelitis/meningitis) and consult infectious diseases — do not use short gastroenteritis regimens (AAP, StatPearls).
Enter weight on Kids to calculate doses
Clinical notes
- • Antibiotics are NOT recommended for most immunocompetent children with uncomplicated non-typhoidal Salmonella gastroenteritis — they do not shorten illness and may prolong fecal excretion (ESPGHAN, AAP, NICE, WHO).
- • Antibiotic therapy is indicated for infants <3 months, immunocompromised hosts, sickle cell disease, malignancy, HIV, chronic gastrointestinal disease, bacteremia, invasive or focal infection, and severe toxic illness (AAP Red Book 2024, CPS, ESPID).
- • Obtain stool culture when diagnosis is uncertain, severe disease, outbreak investigation, or before antibiotics in non-urgent cases; blood cultures in at-risk infants and when bacteremia is suspected — tailor therapy to susceptibilities (CDC, ESPGHAN).
- • Supportive care and low-osmolarity oral rehydration remain first-line for all patients; continue feeding once rehydrated; avoid anti-motility agents in bloody diarrhea (ESPGHAN, WHO, NICE).
- • Rising antimicrobial resistance in non-typhoidal Salmonella limits empiric choices — obtain susceptibility testing and modify therapy when results are available (CDC 2024).
- • AAP Red Book — Salmonella infections (2024)
- • Canadian Paediatric Society — Salmonella infections in Canadian children (2024)
- • ESPGHAN / NASPGHAN — Universal recommendations for management of acute diarrhea (2018)
+ 5 more
- • ESPGHAN / ESPID — Evidence-based guidelines for management of acute gastroenteritis (2014)
- • ESPID — Antibiotic treatment of acute gastroenteritis in children (2018)
- • CDC — Salmonella (Diagnosis and Treatment) (2024)
- • NICE NG84 — Diarrhoea and vomiting in under 5s (2017)
- • WHO Pocket Book of Hospital Care for Children (2022)