Effective antimicrobial therapy in the treatment of shigellosis, especially in children, may shorten the duration of illness and may achieve rapid bacteriologic cure. In a prospective, randomized open study, Varsano and associates compared the efficacy of ceftriaxone with that of ampicillin in the treatment of shigellosis in children.
The study included 40 children with severe dysentery caused by infection with Shigella organisms. The mean age of the children was 4.5 years. During a five-day treatment period, 20 of the children received ceftriaxone (50 mg per kg per day) and 20 received ampicillin (100 mg per kg per day). Both drugs were initially given intravenously for one to two days. Ceftriaxone was continued intramuscularly, and ampicillin was continued orally.
All of the Shigella organisms isolated were susceptible to ceftriaxone; 28 percent were resistant to ampicillin. Diarrhea persisted for a mean of 2.5 days in the patients receiving ceftriaxone and for a mean of 6.8 days in the patients receiving ampicillin. At the end of five days of therapy, stood cultures were negative for Shigella organisms in 12 (60 percent) of the patients in the ampicillin group and in all of the patients in the ceftriaxone group.
Bacteriologic relapses were observed in eight patients (40 percent) who received ampicillin, but in none of the patients who received ceftriaxone. Bacteriologic failure in patients in the ampicillin group, in most cases, was treated with ceftriaxone; persistent clearing of Shigella organisms from stool was finally achieved in this group a mean of 11.75 days after therapy was initiated, compared with 1.85 days in the patients who were initially treated with ceftriaxone. The only drug-related side effect was a rash, which developed in one child during therapy with ceftriaxone.
The authors conclude that in children with severe shigellosis, ceftriaxone therapy for five days is more effective than ampicillin therapy in the clinical cure and eradication of Shigella organisms from stool. Shorter courses of therapy may be equally effective. Ceftriaxone way also effective when administered after failure of ampicillin therapy. (Journal of Pediatrics, April 1991, vol. 188, p. 627.)
COPYRIGHT 1991 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group
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