American Board of Internal Medicine (ABIM) Certification Practice Exam

In treating mild nontyphoidal Salmonella gastroenteritis in otherwise healthy patients, what is the recommended course of action?

1. Initiate antibiotic therapy immediately

2. Administer supportive care only

3. Withhold therapy to prevent increased bacterial shedding

4. Perform stool culture for sensitivity testing

The correct answer is: Withhold therapy to prevent increased bacterial shedding

In the management of mild nontyphoidal Salmonella gastroenteritis in otherwise healthy individuals, the recommended approach is generally to withhold antibiotic therapy. This is primarily because antibiotics can prolong the duration of bacterial shedding in the stool and may contribute to complications without providing a clear benefit in cases of mild gastroenteritis. Supportive care is crucial and typically involves ensuring adequate hydration and electrolyte balance, as the illness is often self-limiting in healthy individuals. Most patients will recover without any specific antimicrobial treatment. Antibiotic therapy is usually reserved for severe cases, immunocompromised patients, or instances where there is a high risk of complications. Furthermore, the rationale for avoiding antibiotics lays in the understanding of how the human immune response interacts with such infections. Initiating immediate antibiotic therapy might not only be unnecessary but could also be counterproductive by interfering with the natural resolution of the infection. Stool culture and sensitivity testing, while beneficial for certain cases, is not routinely recommended for mild infections where the clinical picture remains uncomplicated. Hence, the primary focus remains on supportive care, reinforcing the practice of allowing the body's immune system to combat the infection naturally while managing hydration.