From the Guidelines
The recommended treatment for Shigella infections is azithromycin or ceftriaxone, as these antibiotics have been shown to be effective in treating the infection, with consideration of local resistance patterns 1. When considering treatment for Shigella infections, it's essential to weigh the severity of the case and the patient's risk factors.
- For mild to moderate cases, oral rehydration with fluids containing electrolytes is the primary treatment.
- Antimotility agents like loperamide should be avoided as they can worsen the infection.
- For severe cases or in high-risk patients, antibiotic therapy is recommended. Some key points to consider when choosing an antibiotic for Shigella infections include:
- Azithromycin is a recommended first-line treatment, with a dosage of 500mg once daily for 3 days 1.
- Ceftriaxone is also a recommended treatment, particularly for confirmed Shigella spp. infections, and is categorized as a Watch antibiotic 1.
- Fluoroquinolones, such as ciprofloxacin, may be considered, but their use should be cautious due to concerns of resistance and potential harm 1.
- Trimethoprim-sulfamethoxazole may be used as an alternative, but its effectiveness can be limited by resistance patterns 1. It's crucial to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions, and to consider the most recent and highest-quality evidence available 1.
From the FDA Drug Label
For the treatment of enteritis caused by susceptible strains of Shigella flexneri and Shigella sonnei when antibacterial therapy is indicated An identical daily dosage is used for 5 days in the treatment of shigellosis The usual adult dosage in the treatment of ... shigellosis is 1 sulfamethoxazole and trimethoprim DS tablet every 12 hours for 5 days
The recommended treatment for Shigella infections is trimethoprim-sulfamethoxazole. The dosage for adults is 1 DS tablet every 12 hours for 5 days. For children, the dosage is based on weight, with a recommended dose of 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours for 5 days 2.
- Key points:
- Treatment duration: 5 days
- Adult dosage: 1 DS tablet every 12 hours
- Pediatric dosage: based on weight 2
From the Research
Shigella Treatment Overview
- Shigella infections are a significant public health problem, especially in developing countries, and can cause bloody diarrhea and dysentery.
- The American Academy of Pediatrics (AAP) recommends alternative antibiotics such as cefixime, ceftriaxone, azithromycin, and fluoroquinolones for the treatment of Shigella species infections in children, due to increasing resistance to first-line antibiotics like ampicillin and trimethoprim-sulfamethoxazole 3.
Antibiotic Treatment Options
- Azithromycin has been shown to be effective in the treatment of moderate to severe shigellosis caused by multidrug-resistant Shigella strains, with a clinical success rate of 82% and a bacteriological success rate of 94% 4.
- Ciprofloxacin is also effective in treating shigellosis, with a clinical success rate of 89% and a bacteriological success rate of 100% 4.
- However, the use of fluoroquinolones like ciprofloxacin may promote mutant selection and resistance in Shigella species, especially in areas with high prevalence of resistant strains 5, 6.
- Ceftriaxone is another alternative antibiotic that can be used to treat Shigella infections, but its use may also promote mutant selection and resistance 5.
Resistance Patterns and Treatment Recommendations
- Resistance patterns of Shigella species vary by region and country, with some areas showing high levels of resistance to fluoroquinolones and other antibiotics 6, 7.
- In Iranian children, ciprofloxacin can still be used as a first-line antibiotic for Shigella infections, but second-line antibiotics like ceftriaxone and azithromycin may not be effective due to high resistance rates 6.
- In Vietnam, gatifloxacin and ciprofloxacin have been shown to be similarly effective in treating uncomplicated shigellosis in children, with similar clinical failure rates and time to cessation of symptoms 7.