Article

Antibiotics for the treatment of dysentery in children

Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
International Journal of Epidemiology (Impact Factor: 9.18). 04/2010; 39 Suppl 1(Suppl 1):i70-4. DOI: 10.1093/ije/dyq024
Source: PubMed

ABSTRACT

Ciprofloxacin, ceftriaxone and pivmecillinam are the antibiotics currently recommended by the World Health Organization (WHO) for the treatment of dysentery in children; yet there have been no reviews of the clinical effectiveness of these antibiotics in recent years.
We reviewed all literature reporting the effect of ciprofloxacin, ceftriaxone and pivmecillinam for the treatment of dysentery in children in the developing countries. We used a standardized abstraction and grading format and performed meta-analyses to determine the effect of treatment with these antibiotics on rates of treatment failure, bacteriological failure and bacteriological relapse. The CHERG Standard Rules were applied to determine the final effect of treatment with these antibiotics on diarrhoea mortality.
Eight papers were selected for abstraction. Treatment with ciprofloxacin, ceftriaxone or pivmecillinam resulted in a cure rate of >99% while assessing clinical failure, bacteriological failure and bacteriological relapse.
The antibiotics recommended by the WHO--ciprofloxacin, ceftriaxone and pivmecillinam--are effective in reducing the clinical and bacteriological signs and symptoms of dysentery and thus can be expected to decrease diarrhoea mortality attributable to dysentery.

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    • "Early malnutrition is also linked to poor cognitive functioning and learning capacity (Scrimshaw 1998; Worobey et al. 2006), which in the long term leads to lower labour productivity and poverty (Wagstaff & Watanabe 1999; Grosse & Roy 2008; Hoddinott et al. 2008). Clinical interventions for diarrhoea and respiratory infections such as antibiotics, probiotics and zinc have been implemented and assessed under various environmental settings (Das et al. 2010, 2012; Soares-Weiser et al. 2010; Theodoratou et al. 2010; Traa et al. 2010; Lazzerini & Ronfani 2011; Dennehy 2012; Dinleyici et al. 2012). In contrast, non-clinical interventions including education and training programmes, and/or improved sanitation, water supply and quality, and nutrition are comparatively under-studied. "
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    ABSTRACT: Objective To assess the effectiveness of non-clinical interventions against acute respiratory infections and diarrheal diseases among young children in developing countries.Methods Experimental and observational impact studies of non-clinical interventions aimed at reducing the incidence of mortality and/or morbidity among children due to acute respiratory infections and/or diarrhoeal diseases were reviewed, following the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines.ResultsEnhancing resources and/or infrastructure, and promoting behavioural changes, are effective policy strategies to reduce child morbidity and mortality due to diarrhoeal disease and acute respiratory infections in developing countries. Interventions targeting diarrhoeal incidence generally demonstrated a reduction, ranging from 18.3% to 61%. The wide range of impact size reflects the diverse design features of policies and the heterogeneity of socio-economic environments in which these policies were implemented. Sanitation promotion at household level seems to have a greater protective effect for small children.Conclusion Public investment in sanitation and hygiene, water supply and quality, and the provision of medical equipment that detect symptoms of childhood diseases, in combination of training and education for medical workers, are effective policy strategies to reduce diarrhoeal diseases and acute respiratory infections. More research is needed in the countries that are most affected by childhood diseases. There is a need for disaggregation of analysis by age-cohorts, as impact effectiveness of policies depends on children's age.This article is protected by copyright. All rights reserved.
    Full-text · Article · Nov 2014 · Tropical Medicine & International Health
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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]. On the other hand, when two different antibiotics (Pivmecillinam and Ciprofloxacin) were used it resulted in 82% reduction in clinical failure (RR 0.18; 95% CI: 0.10, 0.33). "
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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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