Comparison of single-dose treatment with norfloxacin and standard 5-day treatment with trimethoprim-sulfamethoxazole for acute shigellosis in adults

Abstract

Shigellae have been shown to be highly susceptible to new quinolone agents, with average MICs for 90% of isolates of <0.1 ,ug/ml. Because these agents also reach high concentrations in the stool after a single dose, the effectiveness of a single 800-mg dose of norfloxacin and of 5-day treatment with trimethoprim-sulfamethoxazole (TMP-SMX) were compared in a randomized trial. Patients with clinical dysentery received one of these treatment regimens, and clinical data and follow-up culture results were analyzed for patients whose stool culture on presentation grew shigellae. When 55 patients with shigellosis (26 treated with TMP-SMX, 29 treated with norfloxacin) whose bacterial isolates were susceptible to the antibiotic given were compared by treatment group, no significant differences were seen in days of illness (mean, 2.5 + 0.65 days with TMP-SMX and 2.0 ± 0.47 days with norfloxacin; P = 0.200) or number of unformed stools after starting treatment (mean, 9.7 ± 2.37 stools with TMP-SMX and 7.6 ± 3.19 stools with norfloxacin; P = 0.312). Resistance in vitro to TMP-SMX was seen in 15% of Shigella isolates, whereas none was resistant to norfloxacin. Bacteriologic failure was found in 1 patient among 24 receiving TMP-SMX and in none of 25 patients receiving norfloxacin. One single dose of norfloxacin was as effective as 5 days of treatment with TMP-SMX in these adults with shigellosis.

The Practice of Travel Medicine: Guidelines by the Infectious Diseases Society of America

“…The inactivated, oral, Vibrio cholerae whole cell/B subunit vaccine (Dukoral [SBL Vaccine]) confers limited [181][182][183] Ciprofloxacin 500 mg po bid [184][185][186][187][188][189][190] Ofloxacin 200 mg po bid [191][192][193] Levofloxacin 500 mg po qd [16] Azithromycin 1000 mg po once [16,194] Rifaximin e 200 mg po tid [17,184,195] a There is currently no antibiotic with demonstrated efficacy in prophylaxis against Campylobacter species. protection against heat-labile enterotoxin-producing Escherichia coli in persons who live in endemic regions [164].…”

Management of infectious diarrhoea

“…Antibiotics are recommended for the treatment of dysentery due to most organisms [50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] (table 5). However, antibiotic therapy for campylobacter 56 57 and EHEC infection remains controversial.…”

Use of quinolones in the treatment of gastrointestinal infections

“…When TMP-resistant Shigella dysenteriae 1 (Shiga bacillus) became epidemic in Zaire, nalidixic acid led to a reduction in the mortality rate (27,31). Norfloxacin, ciprofloxacin and ofloxacin each have been evaluated in shigellosis in adults and found to be effective either in clinical trials comparing the agents to TMP-SMX or to a placebo (22)(23)(24)33). This led to the use of the new fluorinated quinolones which have remained active against these strains (27).…”

“…After several years of widespread drug usage, nalidixic acid resistance occurred in Africa and Southern Asia (27,31). The optimal duration of therapy with quinolones has not been established, available evidence suggesting five days, three days and a single dose are all effective (22)(23)(24)33). Norfloxacin, ciprofloxacin and ofloxacin each have been evaluated in shigellosis in adults and found to be effective either in clinical trials comparing the agents to TMP-SMX or to a placebo (22)(23)(24)33).…”