Telephone calls from primary care physicians to those of us in academia about clinical problems are a touchstone of their uncertainties. By that gauge, few things confound clinicians more than treatment of Salmonella enteritis. A great many clinical studies have reported conflicting results of advantageous, adverse, or indifferent effects of antibiotic therapy in this common illness. Textbooks are uniform in stating that antibiotic therapy does not improve the diarrhea and causes prolongation of the convalescent carrier state, but that is more a tribute to the influence of certain investigators than an objective evaluation of the literature.
A couple of years ago, while preparing the report on a study of Salmonella enteritis that showed no benefit of antibiotics over placebo on the duration of diarrhea but no material prolongation of the carrier state, I found myself sinking into the frustrating morass of conflicting studies. A simple maneuver clarified things. I prepared