cefotaxime and Dysentery--Bacillary

Shigellosis is still an important health problem in developing and underdeveloped countries as it is resistance to commonly used antibiotics including ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol and tetracycline. Between May 1996 and October 1996, in a prospective randomized double-blind trial, cefixime was compared with ampicillin-sulbactam, both given orally for a period of 5 days, for the treatment of 80 children with acute bloody diarrhea. Forty patients were treated with a single-dose (8 mg/kg per day) of cefixime and the other 40 patients were given three doses of 100 mg/kg per day of ampicillin-sulbactam. After identification of Shigella organisms in stool specimens, nine patients in the cefixime receiving group and six patients in the ampicillin-sulbactam receiving group were excluded from the study. Differences in average age, sex and weight between the cefixime and ampicillin-sulbactam group were statistically meaningless (P > 0.05). Fever and bloody diarrhea were universal features. The efficacy of cefixime was found to be better than ampicillin-sulbactam. Patients given cefixime had a shorter duration of fever (P < 0.01), shorter duration to disappearance of blood in the stool (P < 0.01), reduced time with diarrhea (P < 0.01) and reduced hospitalization time during the 5 study days (P < 0.01) than patients given ampicillin-sulbactam. No adverse effects were observed in the two study groups. This controlled trial showed good efficacy with cefixime compared to ampicillin-sulbactam in the treatment of shigellosis. Single-dose daily oral therapy with cefixime also showed good tolerability. Cefixime should be considered as an alternative drug of choice for shigellosis in children.

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Cefixime; Cefotaxime; Child; Child, Preschool; Double-Blind Method; Dysentery, Bacillary; Female; Humans; Infant; Male; Prospective Studies; Sulbactam

To compare the efficacy of cefixime with that of pivamdinocillin in the treatment of adults with acute dysentery caused by Shigella infection.. Randomized, double-blind clinical trial.. A diarrhea treatment center in Dhaka, Bangladesh.. 30 men with dysentery lasting 72 hours or less.. Patients were randomly assigned to receive either 400 mg of cefixime every 24 hours (n = 15) or 400 mg of pivamdinocillin every 6 hours (n = 15) for 5 days. All patients were hospitalized for 6 days. Patients in whom initial drug therapy failed received alternative antimicrobial therapy.. Physical examinations were done and symptoms were recorded daily, and body temperatures were measured every 6 hours. Stools were counted and examined for consistency and for the presence of blood and mucus. Therapy failed if symptoms of dysentery persisted for more than 72 hours or if, on study day 5, a patient had six stools, one watery or bloody-mucoid stool, or an oral temperature higher than 37.8 degrees C. Bacteriologic failure of therapy occurred if Shigella could be isolated from a stool sample on or after study day 3.. Therapy failed in seven (47%) patients given cefixime but in none of the patients given pivamdinocillin (P = 0.006). Patients given cefixime had longer duration of fever (median, 6 hours compared with 0 hours, P = 0.019), longer duration of the period with dysenteric stools (median, 4 days compared with 1 day, P = 0.001), and more stools during the 6 study days (median, 65 compared with 28, P = 0.002) than patients treated with pivamdinocillin. Bacteriologic failure of therapy occurred in 60% of patients (9 of 15) given cefixime and 13% of those (2 of 15) given pivamdinocillin (P = 0.009).. Cefixime is ineffective in treating shigellosis in adults when used in the standard recommended dosage.

Topics: Adolescent; Adult; Amdinocillin Pivoxil; Anti-Bacterial Agents; Cefixime; Cefotaxime; Double-Blind Method; Dysentery, Bacillary; Follow-Up Studies; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Shigella; Treatment Failure

We compared the clinical and bacteriologic response of 5-day treatment with cefixime, 8 mg/kg per day, with the response to trimethoprim-sulfamethoxazole (TMP-SMX), 10-50 mg/kg per day, the currently recommended therapy. Of the assessable children with acute, culture-proven shigellosis, 38 received cefixime and 39 received TMP-SMX. Pretreatment data on the two study groups were similar. In the first group, all isolates were susceptible to cefixime; in the TMP-SMX group, 32 isolates were resistant and 7 were susceptible to TMP-SMX. Clinical response (day 5) showed cure, improvement, and failure in 89%, 8%, and 3%, respectively, of the cefixime group, and in 25%, 44%, and 31%, respectively, of the TMP-SMX-resistant group (p < 0.001). Bacteriologic cure (day 3) occurred in 78% and 23% of the cefixime and TMP-SMX-resistant groups, respectively (p < 0.001). Clinical or bacteriologic relapse (day 12) was infrequent in both groups. The response to treatment of the cefixime and the TMP-SMX-susceptible groups was similar. No significant side effects were noted. We conclude that cefixime is superior to TMP-SMX in the treatment of suspected shigellosis in areas with a high rate of resistance to TMP-SMX.

Topics: Adolescent; Cefixime; Cefotaxime; Child; Child, Preschool; Diarrhea, Infantile; Double-Blind Method; Dysentery, Bacillary; Female; Humans; Infant; Male; Prospective Studies; Shigella; Shigella boydii; Shigella flexneri; Shigella sonnei; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Gastroenteritis is one of the leading cause of illnesses through the world, especially in developing countries.Salmonella and Shigella infections are considered as the main public health problems in children. The aim of this study was to detect the prevalence and antimicrobial susceptibility of Salmonella and Shigella spp. among children with gastroenteritis in an Iranian referral hospital.. During April 2013 to April 2014, all medical records of children with gastroenteritis admitted to a pediatric medical center were evaluated. Positive stool cultures of children were evaluated and frequency of Salmonella and Shigella spp. and their antimicrobial susceptibility were detected.. In this study, 676 patients with the mean age of 24.94 months were enrolled. Eighty-eight (42%) Salmonella spp., 85 (40%) Shigella spp., 33 (16%) E. coli and 5(2%) candida albicans were isolated from 211 positive stool cultures. Among 85 Shigella spp. isolates, S. sonnei, S. flexneri and other Shigella spp. were isolated from 39 (46%) isolates, 36(42%) and 10(12%), respectively. Among 88 isolated Salmonella spp., 36 (41%) isolates were Salmonella Serogroup D, 26 (30%) were Salmonella Serogroup B, 20 (23%) isolates were Salmonella Serogroup C and 6 (7%) were other Salmonella spp. isolates. Thirty-eight percent of Salmonella serogroup B were resistant to nalidixic acid, while higher frequency of nalidixic acid resistant was found in Salmonella serogroup C and Salmonella serogroup D. The higher frequency of ampicillin resistant was found in Shigella spp. than Salmonella spp. High frequency of cefotaxime resistant was seen in S. sonei and S. flexneri (77% and 56%, respectively), whereas more than 90% of Salmonella serogroup B, C and D were susceptible to this antibiotic.. In conclusion, Shigella and Salmonella serogroups can be considered as important etiological agents of acute diarrhea in children. Since the prevalence of antibiotic resistance is increasing in recent years in Iran, further studies on the prevalence, antimicrobial susceptibility pattern and mechanisms of antibiotic resistance in these species is highly recommended.

Topics: Adolescent; Anti-Infective Agents; Cefotaxime; Child; Child, Preschool; Diarrhea; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Escherichia coli; Feces; Female; Gastroenteritis; Hospitals; Humans; Infant; Iran; Male; Microbial Sensitivity Tests; Nalidixic Acid; Prevalence; Retrospective Studies; Salmonella; Salmonella Infections; Serogroup; Shigella

We report a case of CTX-M-55-type extended-spectrum β-lactamase (ESBL)-producing Shigella sonnei infection in a 27-year-old Korean woman who had traveled to China. The patient was admitted to the hospital due to abdominal pain, watery diarrhea, and fever (39.3℃). S. sonnei was isolated from her stool specimens, and the pathogen was found to be resistant to cefotaxime due to CTX-M-55-type ESBL. Insertion sequence (IS)Ecp1 was found upstream of the blaCTX-M-55 gene. The blaCTX-M-55 gene was transferred from the S. sonnei isolate to an Escherichia coli J53 recipient by conjugation. Pulsed-field gel electrophoresis and Southern blotting revealed that the blaCTX-M-55 gene was located on a plasmid of approximately 130 kb.

Topics: Adult; Anti-Bacterial Agents; Asian People; beta-Lactamases; Cefotaxime; China; Drug Resistance, Bacterial; Dysentery, Bacillary; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Feces; Female; Humans; Plasmids; Republic of Korea; Shigella sonnei; Travel

Topics: beta-Lactamases; Child; Child, Preschool; Drug Resistance, Bacterial; Dysentery, Bacillary; Female; Humans; Infant; Male; Shigella; United States

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ceftazidime; Conjugation, Genetic; Drug Resistance, Bacterial; Dysentery, Bacillary; Genes, Bacterial; Humans; Microbial Sensitivity Tests; Risk Factors; Salmonella; Salmonella Infections; Shigella; Travel; Washington

Topics: Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; beta-Lactams; Cefotaxime; Dysentery, Bacillary; Hong Kong; Humans; Microbial Sensitivity Tests; Shigella

This report describes a case of urinary tract infection caused by Shigella sonnei in a 6-y-old girl with vesicoureteric reflux and a preceding history of gastroenteritis. The strain was resistant to ampicillin and cotrimoxazole, and treatment with cefotaxime eradicated the infection. The role of Shigellae as urinary tract pathogens is reviewed and possible sources of infection are discussed.

Topics: Anti-Bacterial Agents; Cefotaxime; Child; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Female; Humans; Shigella sonnei; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Bacteremia; Cefotaxime; Cephalosporins; Cerebrospinal Fluid; Dysentery, Bacillary; Humans; Infant; Male; Meningitis, Bacterial; Shigella sonnei

Topics: Cefotaxime; Cephalosporins; Child, Preschool; Drug Resistance, Microbial; Dysentery, Bacillary; Feces; Humans; Male; Microbial Sensitivity Tests; Shigella flexneri; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Cefotaxime; Child; Disease Outbreaks; Drug Resistance, Microbial; Dysentery, Bacillary; Humans; Spain