针对经选择患者组全部患者的治疗推荐
第一选择
环丙沙星
:
儿童：20-30mg/kg/日口服，分为2次，最大剂量为1500mg/日；成人：500mg口服，每日2次，或400mg静注，每12小时一次。
第二选择
阿奇霉素
:
儿童：10mg/kg/日口服，最大剂量500mg/日；成人：第一天1000mg口服，每日1次，之后每日1次，每次500mg。
或
头孢曲松
:
儿童：60mg/kg/日，分为1到2次静脉注射；成人：每24小时静脉注射2g
或
头孢噻肟
:
儿童：100mg/kg/日，分为4次静脉注射；成人：每8小时静脉注射1-2g
第三选择
甲氧苄啶/磺胺甲恶唑
:
＞2个月儿童：12mg/kg/日，分为2次口服；成人：每日2次口服160/800mg
更多
甲氧苄啶/磺胺甲恶唑
只根据甲氧苄啶成分含量制定儿科治疗用量。
或
阿莫西林
:
＞3个月儿童：50-100mg/kg/日，分为2-3次口服；成人：每日3次口服500mg
抗菌药物建议以下人群使用：＜3个月的婴儿（有些提倡＜1岁），＞50岁的成人，免疫抑制患者，血管异常患者如人工瓣膜植入或搭桥，人工关节患者。[29]Hohmann EL. Nontyphoidal salmonellosis. Clin Infect Dis. 2001;32:263-269.https://cid.oxfordjournals.org/content/32/2/263.full.pdf+htmlhttp://www.ncbi.nlm.nih.gov/pubmed/11170916?tool=bestpractice.com[30]Pegues DA, Miller SI. Salmonella species, including Salmonella Typhi. In: Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 7th ed. Philadelphia, PA: Churchill Livingstone; 2010:2887-2903.[61]Gilbert DN, Chambers HF, Eliopoulos GM, et al. The Sanford guide to antimicrobial therapy, 47th ed. Sperryville, VA: Antimicrobial Therapy, Inc.; 2017.
考虑到阿莫西林、氨苄西林和甲氧苄啶/磺胺甲噁唑的耐药率不断上升，氟喹诺酮类如环丙沙星目前是优选药物。[62]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;55:1148-1154.http://aac.asm.org/content/55/3/1148.longhttp://www.ncbi.nlm.nih.gov/pubmed/21199924?tool=bestpractice.com值得注意的是氟喹诺酮耐药也有报道，因此当患者对抗生素治疗临床效果不佳时应根据药敏结果更换药物。[63]Nakaya H, Yasuhara A, Yoshimura K, et al. Life-threatening infantile diarrhea from fluoroquinolone-resistant Salmonella enterica typhimurium with mutations in both gyrA and parC. Emerg Infect Dis. 2003;9:255-257.http://www.ncbi.nlm.nih.gov/pubmed/12604000?tool=bestpractice.com[64]Whichard JM, Gay K, Stevenson JE, et al. Human Salmonella and concurrent decreased susceptibility to quinolones and extended-spectrum cephalosporins. Emerg Infect Dis. 2007;13:1681-1688.http://www.ncbi.nlm.nih.gov/pubmed/18217551?tool=bestpractice.com
头孢曲松和头孢噻肟通常对沙门氏菌有效。东南亚、美国和其它地区沙门氏菌对头孢曲松和头孢噻肟的耐药性不断上升。[64]Whichard JM, Gay K, Stevenson JE, et al. Human Salmonella and concurrent decreased susceptibility to quinolones and extended-spectrum cephalosporins. Emerg Infect Dis. 2007;13:1681-1688.http://www.ncbi.nlm.nih.gov/pubmed/18217551?tool=bestpractice.com[66]Sjölund-Karlsson M, Rickert R, Matar C, et al. Salmonella isolates with decreased susceptibility to extended-spectrum cephalosporins in the United States. Foodborne Pathog Dis. 2010;7:1503-1509.http://www.ncbi.nlm.nih.gov/pubmed/20704496?tool=bestpractice.com一些研究（包括体内和体外研究）表明，碳青霉烯类和替加环素可能对非伤寒沙门氏菌有效，但在推荐用于临床实践前，仍需进一步研究。[70]Tang HJ, Ko WC, Chen CC, et al. In vitro and in vivo intracellular killing effects of tigecycline against clinical nontyphoid Salmonella isolates using ceftriaxone as a comparator. Antimicrob Agents Chemother. 2011;55:2755-2759.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101431/pdf/zac2755.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/21402846?tool=bestpractice.com[71]Tang HJ, Chen CC, Zhang CC, et al. Use of Carbapenems against clinical, nontyphoid Salmonella isolates: results from in vitro and in vivo animal studies. Antimicrob Agents Chemother. 2012;56:2916-2922.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370812/pdf/zac2916.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/22470122?tool=bestpractice.com
儿童的治疗十分复杂，考虑到沙门氏菌菌株耐药性不断增加以及氟喹诺酮类对儿科患者的潜在毒性。一项有关环丙沙星治疗伤寒热的研究显示环丙沙星可能可安全用于沙门氏菌感染治疗。[72]White NJ, Dung NM, Vinh H, et al. Fluoroquinolone antibiotics in children with multidrug resistant typhoid. Lancet. 1996;348:547.http://www.ncbi.nlm.nih.gov/pubmed/8757168?tool=bestpractice.com
环丙沙星由于具有可致关节病潜在风险，一般不推荐用于儿童，但有报道称对于该人群某些适应证是有效和安全的。[79]Adefurin A, Sammons H, Jacqz-Aigrain, et al. Ciprofloxacin safety in paediatrics: a systematic review. Arch Dis Child. 2011;96:874-880.http://adc.bmj.com/content/96/9/874.longhttp://www.ncbi.nlm.nih.gov/pubmed/21785119?tool=bestpractice.com
通常抗生素疗程为3到7天，或直到发热消退。[30]Pegues DA, Miller SI. Salmonella species, including Salmonella Typhi. In: Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 7th ed. Philadelphia, PA: Churchill Livingstone; 2010:2887-2903.[61]Gilbert DN, Chambers HF, Eliopoulos GM, et al. The Sanford guide to antimicrobial therapy, 47th ed. Sperryville, VA: Antimicrobial Therapy, Inc.; 2017.对免疫受损患者或复发疾病的抗生素疗程需延长至7到14天。
药物剂量基于正常的肝肾功能制定。
]