Antibiotic treatment for Shigella infections

Klontz KC, Singh N. Treatment of drug-resistant Shigella infections. Expert Rev Anti Infect Ther. 2015 Jan;13(1):69-80.

Since the introduction of sulfonamides in the late 1930s, selective pressure and the widespread dissemination of mobile genetic elements conferring antimicrobial resistance have forced clinicians to seek successive agents for the treatment of multidrug-resistant shigellosis. Over the decades, the principal antibiotics used to treat Shigella infections have included tetracycline, chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, and nalidixic acid. Presently, ciprofloxacin, azithromycin, and ceftriaxone serve as the mainstays of treatment, although growing evidence has documented decreased susceptibility or full resistance to these agents in some regions. With diminishing pharmaceutical options available, there is an enhanced need for preventive measures in the form of improved sanitation and hygiene standards, strict use of currently effective agents, and a safe and effective licensed vaccine.

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Holmes LC. Shigella. Pediatr Rev. 2014 Jun;35(6):261-2.

“The choice of which antibiotic to administer is another treatment question. A 2010 Cochrane review of 16 randomized controlled trials evaluating antibiotics for shigella dysentery found all classes of antibiotics had similar efficacy, and the authors were not able to identify a superior class of antibiotics. In the United States, the 2010 National Antimicrobial Resistance Monitoring System found 41% of Shigella species resistant to ampicillin, 48% resistant to trimethoprim-sulfamethoxazole, 2% resistant to ciprofloxacin, and less than 1% resistant to ceftriaxone. Antibiotic resistance in outbreaks has been reported to be much higher. Arvelo et al found 90% of the Shigella strains involved in a large daycare center–associated outbreak resistant to both ampicillin and trimethoprim-sulfamethoxazole. Knowing regional resistance patterns and the susceptibility pattern of the pathogen once available is essential to guide therapy.”

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Christopher PR, et al. Antibiotic therapy for Shigella dysentery. Cochrane Database Syst Rev. 2010 Aug 4;(8):CD006784.

Antibiotics reduce the duration of Shigella dysentery.Regularly updated local or regional antibiotic sensitivity patterns to different species and strains of Shigella are required to guide empiric therapy. More trials adhering to standard guidelines are required to evaluate the role of antibiotics in the treatment of severe forms of Shigella dysentery and in groups who are at high risk of complications.

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Zinc for acute diarrhea

Patel A. Zinc for acute diarrhea and Amoxicillin for pneumonia, do they work? Indian J Pediatr. 2015 Aug;82(8):703-6.

This presentation focuses on author’s research on the mechanisms by which zinc might contribute to the pathogenesis of acute diarrhea and the degree of success achieved in diarrhea control and treatment by zinc supplementation including its impact on mortality. However, emerging evidence in terms of controlled studies in humans beckons a more complete understanding of the mechanistic basis for zinc supplementation. Current evidence indicates that studies specifically addressing the variability in response to zinc supplementation need to be undertaken to better comprehend these mechanisms.

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Liberato SC, Singh G, Mulholland K. Zinc supplementation in young children: A
review of the literature focusing on diarrhoea prevention and treatment. Clin Nutr. 2015 Apr;34(2):181-8.

Prophylactic zinc has been shown to be effective in decreasing both prevalence and incidence of diarrhoea, reducing respiratory infections and improving growth in children with impaired nutritional status. There is less conclusive evidence of reduction in diarrhoea duration or diarrhoea severity. While prophylactic zinc decreases mortality due to diarrhoea and pneumonia, it has not been shown to affect overall mortality. Therapeutic use of zinc for the treatment of diarrhoea in children has been shown to reduce diarrhoea incidence, stool frequency and diarrhoea duration as well as respiratory infections in zinc deficient children. However, stool output is only reduced in children with cholera. Less conclusive evidence exists for therapeutic zinc reducing mortality due to diarrhoea and respiratory infections. Specific definitions of diarrhoea severity, respiratory infection in further studies as well as examination of prophylactic zinc effectiveness in diarrhoea duration and severity effectiveness of therapeutic zinc in reducing mortality due to diarrhoea and respiratory infections are warranted.

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