From the Guidelines
The recommended treatment for Shigella infection is a fluoroquinolone, such as ciprofloxacin, for 3-7 days, as it is the preferred first-line treatment due to high rates of TMP-SMX resistance in internationally acquired cases and adverse effects in HIV-infected persons 1.
Treatment Options
- Alternative antibiotics include azithromycin for 5 days or TMP-SMX for 3-7 days, depending on antibiotic susceptibilities and local resistance patterns 1.
- For severe cases, immunocompromised patients, the elderly, and young children, antibiotic treatment is strongly recommended to prevent complications and reduce the duration of illness and bacterial shedding.
- In cases of Shigella bacteremia, extending treatment to 14 days may be reasonable, using the agents described previously 1.
Additional Considerations
- Antimicrobial susceptibility testing should guide treatment when available, as resistance is increasingly common.
- Antidiarrheal medications like loperamide should be avoided as they can worsen the infection by delaying bacterial clearance.
- Maintaining proper hydration is essential during treatment, and electrolyte solutions may be necessary for those with significant fluid loss.
- Empiric antimicrobial therapy in adults should be either a fluoroquinolone, such as ciprofloxacin, or azithromycin, depending on local susceptibility patterns and travel history 1.
From the FDA Drug Label
Infectious Diarrhea caused by Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, Shigella boydii†, Shigella dysenteriae, Shigella flexneri or Shigella sonnei† when antibacterial therapy is indicated.
The recommended treatment for Shigella in stool is ciprofloxacin (PO), as it is indicated for the treatment of infectious diarrhea caused by Shigella species, including Shigella boydii, Shigella dysenteriae, Shigella flexneri, and Shigella sonnei [ 2 ].
From the Research
Treatment Options for Shigella in Stool
- The recommended treatment for Shigella in stool includes antibiotics such as azithromycin, ciprofloxacin, and levofloxacin 3, 4, 5.
- Azithromycin is effective in the treatment of moderate to severe shigellosis caused by multidrug-resistant Shigella strains 3.
- Ciprofloxacin is also effective, but its use is limited due to increasing resistance, particularly among Campylobacter spp. 5.
- The choice of antibiotic should take into account the travel destination and regional differences in the predominance of pathogens and resistance levels 5.
Antibiotic Resistance and Treatment Failure
- Shigella strains with decreased susceptibility to azithromycin have been reported, highlighting the need for monitoring antimicrobial resistance patterns 6.
- Treatment failure can occur due to antibiotic resistance, and alternative treatments such as ciprofloxacin or levofloxacin may be necessary 3, 4.
- The use of antimotility agents is contraindicated, and oral rehydration salt should be given concurrently to prevent or correct dehydration 7.
Additional Considerations
- Hand-washing practices with plenty of water and soap can help prevent the transmission of infection from person to person 7.
- Feeding during and after shigellosis is emphasized, and a search is ongoing for an effective vaccine against Shigella 7.
- The treatment of shigellosis should be guided by the severity of symptoms, the presence of antibiotic resistance, and the patient's overall health status 4, 5.