Antibiotic Treatment for Bacterial Dysentery in Children
Ciprofloxacin is the first-line antibiotic treatment for bacterial dysentery (shigellosis) in children, with azithromycin and cefixime as appropriate second-line options, especially in regions with high ciprofloxacin resistance. 1
First-line Treatment
- Ciprofloxacin: 15 mg/kg per dose, oral administration 1
- Despite concerns about potential adverse effects like arthropathy in children, the WHO Working Group considers ciprofloxacin highly effective and appropriate for shigellosis in children 1
Second-line Options (when ciprofloxacin resistance is suspected or confirmed)
Azithromycin: 10 mg/kg on day 1, followed by 5 mg/kg daily for 4 days OR 1000 mg single dose 1
Cefixime: Appropriate oral alternative when ciprofloxacin resistance is high 1
- Effective against shigellosis in pediatric patients 1
Parenteral ceftriaxone: For severe cases or when oral medications cannot be tolerated 1, 3
Treatment Considerations
- Antibiotic selection should be guided by local resistance patterns, particularly in regions like Southeast Asia where ciprofloxacin resistance is high 1
- Current WHO recommendations for shigellosis treatment have been shown to reduce clinical failure rates by 82% 1
- Empiric treatment should be initiated promptly for suspected bacterial dysentery without waiting for culture results 4, 5
- Avoid antimotility agents (such as loperamide) in children with acute dysentery 6
Resistance Patterns to Consider
- Higher resistance rates to antibiotics are observed in Asia-Africa compared to Europe-America 1
- Resistance rates to ciprofloxacin reached 5.0% in Asia-Africa 1
- Ceftriaxone resistance rates were 2.5% in Asia-Africa versus 0.4% in Europe-America, with rates reaching 14.2% in Asia-Africa after 2007 1
Special Populations
- For children with severe illness or those who are immunocompromised, parenteral therapy with ceftriaxone may be preferred initially 1, 3
- Recent evidence suggests azithromycin may benefit children with acute watery diarrhea of bacterial etiology, not just dysentery 7
Duration of Treatment
- 3-5 days of treatment is typically sufficient for uncomplicated cases 1, 4
- Single-dose regimens may be considered for mild to moderate cases to improve compliance 1
Monitoring and Follow-up
- Assess clinical response within 48 hours of initiating treatment 5
- Consider alternative antibiotics if no improvement is observed after 48 hours 4
- Monitor for potential adverse effects, particularly with fluoroquinolones 1
Remember that bacterial dysentery requires prompt antibiotic treatment to reduce morbidity and mortality, unlike most other causes of pediatric diarrhea which are often viral and self-limiting 3, 4.