Antibiotic therapy for Shigella dysentery

Family Medicine, Christian Medical College, Vellore, Tamilnadu, India, 632004.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 08/2010; 8(8):CD006784. DOI: 10.1002/14651858.CD006784.pub4
Source: PubMed


Shigellosis is a bacterial infection of the colon that can cause diarrhoea, dysentery (diarrhoea with blood and/or mucus) and may lead to death. It occurs mainly in low- and middle-income countries where overcrowding and poor sanitation exist, and may lead to around 1.1 million deaths per year globally, mostly in children under five years. The intention of giving antibiotics in shigellosis is to speed recovery, reduce the seriousness of the disease, and reduce the length of time patients are infective. However, some antibiotics can have serious side effects while others may not be effective against the Shigella bacteria. The review examined both the effectiveness and the safety of antibiotics in treating Shigella dysentery. While antibiotics tested here appeared safe and effective, there was insufficient evidence to suggest which antibiotics were superior. More well designed trials will help inform decision making.

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Available from: Venkatesan Pandian, Jun 15, 2015
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    • "Shigellosis, caused by the bacteria Shigella, is characterized by gastrointestinal illness including diarrhea and fever that may progress to dysentery[1]. Shigella is transmitted by the fecal–oral route, is often asymptomatic, has a low infective dose, and ongoing bacterial shedding can be prolonged if antibiotic therapy is not initiated, regardless of the presence of symptoms[2,3]. Approximately 80% of Shigella infections occur in Asia, estimated to cause 125 million cases of illness and 14 000 deaths in this region annually[1]. "
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    ABSTRACT: Background: Knowledge of relationships between antibiotic susceptibility of Shigella isolates and location of travel or other risk factors can assist clinicians in determining appropriate antibiotic therapy prior to susceptibility testing. We describe relationships between resistance patterns and risk factors for acquisition in Shigella isolates using routinely collected data for notified cases of shigellosis between 2008 and 2012 in Victoria, Australia. Methods: We included all shigellosis case-patients notified during the study period, where Shigella isolates were tested for antimicrobial sensitivity using Clinical and Laboratory Standards Institute breakpoints. Cases were interviewed to collect data on risk factors, including recent travel. Data were analysed using Stata 13.1 to examine associations between risk factors and resistant strains. Results: Of the 500 included cases of shigellosis; 249 were associated with overseas travel and 210 locally acquired. Forty-six of 51 isolates of Indian origin displayed decreased susceptibility or resistance to ciprofloxacin. All isolates of Indonesian origin were susceptible to ciprofloxacin. Twenty-six travel related isolates were resistant to all tested oral antimicrobials. Male to male sexual contact was the primary risk factor for 80% (120/150) of locally acquired infections amongst adult males, characterized by distinct periodic S. sonnei outbreaks. Conclusions: Clinicians should consider travel location as a marker for resistance to common antimicrobials in returning travelers, where severe disease requires empirical treatment prior to the receipt of individual sensitivity testing results. Repeated outbreaks of locally acquired shigellosis among men who have sex with men highlight the importance of prevention and control measures in this high-risk group.
    Full-text · Article · Dec 2015 · Clinical Infectious Diseases
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    • "Reduced episodes of diarrhoea at follow-up were seen with Furazolidone versus no drug (RR 0.21; 95% CI: 0.09, 0.48) as well as with cotrimoxazole versus no drug (RR 0.30; 95% CI: 0.15, 0.59) [72]. However, treatment with one of the three WHO-recommended antibiotics (ciprofloxacin, ceftriaxone and pivmecillinam) resulted in a clinical failure rate of 0.1% (95% CI: −0.2, 0.5%) [73]. "
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    ABSTRACT: Child health is a growing concern at the global level, as infectious diseases and preventable conditions claim hundreds of lives of children under the age of five in low-income countries. Approximately 7.6 million children under five years of age died in 2011, calculating to about 19 000 children each day and almost 800 every hour. About 80 percent of the world's under-five deaths in 2011 occurred in only 25 countries, and about half in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan and China. The implications and burden of such statistics are huge and will have dire consequences if they are not corrected promptly. This paper reviews essential interventions for improving child health, which if implemented properly and according to guidelines have been found to improve child health outcomes, as well as reduce morbidity and mortality rates. It also includes caregivers and delivery strategies for each intervention. Interventions that have been associated with a decrease in mortality and disease rates include exclusive breastfeeding, complementary feeding strategies, routine immunizations and vaccinations for children, preventative zinc supplementation in children, and vitamin A supplementation in vitamin A deficient populations.
    Full-text · Article · Aug 2014 · Reproductive Health
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    • "We reviewed the scientific evidence available for the use of antibiotics in the treatment of diarrhea due to Cholera, Shigella and Cryptosporidium in children, as well as differences in the effectiveness of various antibiotics. A Cochrane review [20] has evaluated the effectiveness of antibiotics for Shigella in children and adults, while the review by Traa et al [21] had evaluated the effectiveness of antibiotics for dysentery and estimated a cure rate of > 99%. We in this review have taken studies with confirmed cases of Shigella only, so have estimated the effect of antibiotics on Shigella cases. "
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    ABSTRACT: Diarrhea is a major contributor to the burden of morbidity and mortality in children; it accounts for a median of 11% of all deaths among children aged less than 5 years, amounting to approximately 0.8 million deaths per year. Currently there is a dearth of literature exploring the effectiveness of antibiotics for diarrhea due to Cholera, Shigella and cryptosporidiosis in children. We reviewed the literature reporting the effect of antibiotics for the treatment of diarrhea due to Cholera, Shigella and Cryptosporidium in children under five years. We used a standardized abstraction and grading format and performed meta-analyses to determine the effect of the treatment with various antibiotics on mortality and rates of clinical and bacteriological/parasitological failure. The CHERG Standard Rules were applied to determine the final effect of treatment with antibiotics on diarrhea morbidity and mortality. For Cholera; the evidence was weak to recommend any effect on mortality. For Shigella; there was no data on mortality; either all-cause or cause specific, hence we used clinical failure rates as a proxy for Shigella deaths and propose that treatment of Shigella dysentery with antibiotics can result in a 82% reduction in diarrhea mortality due to Shigella. For cryptosporidiosis; there was data on all-cause mortality but the evidence was weak hence we used clinical failure rates as a proxy for mortality to estimate that antimicrobial treatment of diarrhea due to cryptosporidiosis can result in a 54% reduction in mortality. There is evidence to recommend antibiotic use for reduction of morbidity and mortality due to Cholera, Shigella and Cryptosporidium. We recommend that more clinical trials should be conducted to evaluate the efficacy and safety of first- and second- line drugs currently in use for treatment for diarrhea and dysentery in both developing and developed countries.
    Full-text · Article · Sep 2013 · BMC Public Health
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