ROSH Gastrointestinal Practice Exam

Which of the following patients with Salmonella enteritis should receive antibiotics?

1. 13-month-old with diarrhea and no signs of volume depletion

2. 13-year-old boy with sickle cell disease

3. 19-year-old man living in a college dorm

4. 8-year-old boy with no medical problems

The correct answer is: 13-year-old boy with sickle cell disease

Antibiotics are indicated in certain high-risk patients who develop Salmonella enteritis due to the potential for more severe disease and complications. Sickle cell disease is a significant underlying condition because these patients are at increased risk for infections, including those caused by encapsulated bacteria and certain pathogens like Salmonella. This increased risk stems from impaired splenic function, leading to a reduced ability to control infections effectively. For the other patients listed, treatment with antibiotics may not be necessary or beneficial. The 13-month-old with diarrhea and no signs of volume depletion is likely experiencing a self-limiting infection and may not require antibiotics unless there are specific indications such as severe dehydration or persistent bacteremia. Similarly, the 19-year-old man living in a college dorm and the 8-year-old boy with no medical problems are both generally healthy individuals. In healthy patients, Salmonella infections are typically self-limited, and antibiotics can lead to complications such as prolonged carriage or development of antibiotic-resistant strains. Thus, the 13-year-old boy with sickle cell disease is the correct choice, as he represents a population at higher risk for severe Salmonella infections, which justifies the use of antibiotics in his management.