What is the treatment for Shigella infection?

From the Guidelines

The treatment for Shigella infection should be with sulfamethoxazole-trimethoprim as the first-line antibiotic, or ceftriaxone as an alternative, due to concerns of resistance and potential harm associated with fluoroquinolones and azithromycin 1. When treating Shigella infection, it is essential to consider the most recent and highest quality evidence to minimize morbidity, mortality, and improve quality of life.

Key Considerations

• The choice of antibiotic depends on local resistance patterns and patient factors, and sulfamethoxazole-trimethoprim is recommended as an Access antibiotic for Shigella infections 1.
• Fluoroquinolones, although previously recommended, are no longer the preferred first-line treatment due to increasing resistance rates and potential harm 1.
• Ceftriaxone is an alternative option for confirmed Shigella infections, as it appears to be more effective than fluoroquinolones 1.
• Good hand hygiene and complete antibiotic courses are crucial for effective treatment and prevention of spread, as Shigella is highly contagious 1.

Treatment Approach

• Most cases of Shigella resolve on their own within 5-7 days with adequate hydration and rest.
• Patients should drink plenty of fluids to prevent dehydration, which is especially important for children and elderly patients.
• For more severe cases or high-risk individuals, antibiotic therapy is recommended, with sulfamethoxazole-trimethoprim or ceftriaxone as the preferred options.
• Antidiarrheal medications like loperamide should be avoided as they can worsen the infection by slowing the clearance of bacteria from the intestines.

Prevention of Spread

• Patients should practice good hand hygiene during and after infection to prevent spreading the bacteria to others.
• Patients should also avoid preparing food for others until at least 48 hours after symptoms resolve.

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 treatment for Shigella infection is ciprofloxacin when antibacterial therapy is indicated, as it is effective against Shigella boydii, Shigella dysenteriae, Shigella flexneri, and Shigella sonnei 2.

From the Research

Treatment for Shigella Infection

• The treatment for Shigella infection may involve antibiotic therapy, with azithromycin being a potential first-line treatment option 3, 4, 5.
• However, the emergence of azithromycin resistance in Shigella has become a concern, and alternative treatments such as ciprofloxacin and levofloxacin may be considered 3, 5.
• The choice of antibiotic should take into account the travel destination and regional differences in the predominance of pathogens and resistance levels 5.
• In addition to antibiotic therapy, management of complications such as sepsis, hypoglycemia, and dehydration is crucial, particularly in severely ill and malnourished patients 6.
• Supportive care, including frequent feedings and hydration, is also important in the treatment of Shigella infection 6.

Antibiotic Resistance

• Azithromycin resistance has been reported in Shigella isolates, with studies identifying multiple mechanisms of resistance, including the presence of macrolide resistance genes such as mph(A) and erm(B) 4.
• The emergence of azithromycin resistance highlights the need for ongoing reconsideration of guidelines for the treatment of shigellosis and the importance of culture and susceptibility testing for suspected and proven shigellosis 3.
• The use of fluoroquinolones, such as ciprofloxacin and levofloxacin, may also be limited by increasing resistance rates, particularly among Campylobacter spp. 5.

Prevention and Control

• Prevention and early antimicrobial therapy are crucial in reducing mortality from shigellosis, particularly in developing countries where access to parenteral broad-spectrum antimicrobial agents may be limited 6.
• Realistic approaches to the reduction of mortality from shigellosis must focus on prevention and early treatment rather than on treatment of established complications 6.