Comparative efficacies of single intravenous doses of ceftriaxone and ampicillin for shigellosis in a placebo-controlled trial

Abstract

To evaluate ceftriaxone for the treatment of shigellosis, 94 adult males with acute dysentery were randomly assigned to receive ceftriaxone (1 g), ampicillin (4 g), or saline placebo intravenously in single doses in a double-blind design. Stool cultures were positive for Shigella dysenteriae in 52 patients, S. flexneni in 38 patients, and other species in 4 patients. Both ceftriaxone and ampicillin caused reductions in the mean duration of fever and the means of daily stool frequency 2 to 4 days after therapy versus placebo (P < 0.05). The ability of ceftriaxone to reduce stool frequency during 6 days after treatment was significant in patients with S. flexneri infections (P < 0.05), whereas S. dysenteriae infections were relatively refractory to improvement by both antibiotics. Neither drug had a significant effect on overall duration of diarrhea, blood in stool, or tenesmus. Ampicillin reduced the mean duration of positive stool cultures after treatment from 2.6 days in the placebo group to 1.1 days (P < 0.05), whereas ceftriaxone did not affect the duration of ShigeUla sp. excretion. These results indicate that single intravenous doses of ceftriaxone and ampicillin caused some clinical improvement in acute shigellosis but only ampicillin exerted a bacteriological effect on Shigella sp. excretion.

Part II. Analysis of data gaps pertaining toShigellainfections in low and medium human development index countries, 1984–2005

“…Most recently, strains of S. dysenteriae type 1 circulating in South Asia have demonstrated resistance to multiple fluoroquinolones, with susceptibility only to azithromycin, pivmecillinam and third-generation cephalosporins [35][36][37][38][39][40][41][42]105]. Studies of the efficacy of these agents against S. dysenteriae type 1 are rare and have only been conducted in adults [107,108]. It is vital to better characterize effective antimicrobial agents and regimens for the treatment of multiplyresistant S. dysenteriae type 1 infection in children and adults ahead of the next epidemic.…”

Strategies to overcome extended-spectrum β-lactamases (ESBLs) and AmpC β-lactamases in shigellae

“…The benefits of chemotherapy were confirmed by a Cochrane review [2] highlighting two placebo-controlled trials which showed that antibiotics reduced the risk of continued diarrhoea by 70-79% [3,4]. Ampicillin, co-trimoxazole (trimethoprim/sulfamethoxazole) and fluoroquinolones were effective but are now compromised by resistance [2], with therapy increasingly shifting to oral oxyiminocephalosporins (ceftibuten, cefixime or cefdinir) or to intravenous (i.v.)…”

Antibiotics for the treatment of dysentery in children

“…Decreasing the bacterial load excreted by a child with dysentery also reduces the probability of fecal–oral transmission to close contacts, such as neighbours, friends or members of the child’s household 4 . Anti-microbial therapy is particularly important in developing countries, where prolonged diarrhoea episodes, including dysentery, can significantly decrease the growth and nutritional status in the affected children 5 , 6 …”