Infectious gastroenteritis caused by
non-typhoidal serovars of Salmonella is usually self-limiting but
life-threatening complications may require appropriate antibiotic therapies.
Probiotics have evolved as potential alternatives to antibiotics in response to
an increasing prevalence of resistant strains, but there are no studies
comparing the effectiveness of both treatment strategies on the same intestinal
microbiota.
Infectious gastroenteritis is one of the most common causes
of disease in children less than five years old, with rotavirus and food-borne
associated non-typhoidal Salmonella predominantly identified as causative
agents. Non-typhoidal Salmonella organisms
can cause asymptomatic carriage as well as self-limited gastroenteritis. Complications
however, include bacteremia and other extra-intestinal manifestations, e.g.
osteomyelitis and meningitis, requiring hospitalization and resulting in the
risk of serious sequelae and death. Antibiotic treatment is usually not
recommended in uncomplicated gastroenteritis because it may prolong the
duration of carriage.
In patients at risk of
bacteremia however, i.e. young infants, immunocompromised patients, patients
with chronic gastrointestinal disease, or patients with malignant diseases,
antibiotic treatment is used even though the incidence of treatment failures attributed
to antibiotic resistant Salmonella strains is increasing and antibiotics may
cause disturbances of the human intestinal ecosystem leading to a disruption of
the barrier effect and overgrowth with commensal microorganisms. Alternative
treatment strategies combating severe Salmonella infections in children are
therefore needed.
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