Treatment Of Shigellosis In Children Research Articles

Decreased Susceptibility of Shigella Isolates to Azithromycin in Children in Tehran, Iran.

Azithromycin (AZT) has widely been used for the treatment of shigellosis in children. Recent studies showed a high rate of decreased susceptibility to azithromycin due to different mechanisms of resistance in Shigella isolates. Accordingly, the purpose of this study was to investigate the role of azithromycin resistance mechanisms of Shigella isolates in Iran during a two-year period. In this study, we investigated the mechanisms of resistance among Shigella spp. that were isolated from children with shigellosis. The minimum inhibitory concentration (MIC) of Shigella isolates to azithromycin was determined by the agar dilution method in the presence and absence of Phe-Arg-β-naphthylamide inhibitor. The presence of 12 macrolide resistance genes was investigated for all isolates by PCR for the first time in Tehran province in Iran. Among the 120 Shigella spp., only the mph(A) gene (49.2%) was detected and other macrolide resistance genes were absent. The phenotypic activity of efflux pump was observed in 1.9% of isolates which were associated with over expression of both omp(A) and omp(W) genes. The high prevalence of the mph(A) gene among DSA isolates may indicate that azithromycin resistance has evolved as a result of antimicrobial selection pressures and inappropriate use of azithromycin.

Emergence of azithromycin and third-generation cephalosporins resistant Shigella isolated from Iranian children

BackgroundShigellosis is still considered a major cause of morbidity and mortality among children. The aims of this study were to determine the antimicrobial susceptibility and resistance mechanism to first line drug such as cephalosporin, azithromycin and prevalence of class 1 and 2 integrons. MethodsWe collected 89 Shigella flexneri and Shigella sonnei from four cities in Iran (Tabriz, Kerman, Urmia and Ardabil). Antimicrobial susceptibility tests were performed by disk diffusion and agar dilution methods. Also, extended-spectrum beta-lactamases (ESBL) genes of integrons were characterized by PCR. ResultsWe were recovered 56 S. flexneri and 33 S. sonnei isolates. Of the 89 isolates, 60 (67.4%) were positive for ESBLs gene and 16 isolates were resistant to azithromycin. Additionally, 71.24% of S. flexneri and S. sonnei strains were harbored class 1 integrons, also 95.82% of theses strains carry off class 2 integrons, respectively. ConclusionsOur findings showed that due to the numerous mechanisms of antibiotic resistance, the selection of appropriate antimicrobial agents for the treatment of shigellosis in children is limited and difficult.

Evaluation of Shigella Species Azithromycin CLSI Epidemiological Cutoff Values and Macrolide Resistance Genes.

Azithromycin (AZM) has been recommended by the American Academy of Pediatrics for the treatment of shigellosis in children. In this study, 502 Shigella species isolated between 2004 and 2014 were tested for AZM epidemiological cutoff values (ECV) by disk diffusion. AZM MICs and the presence of the macrolide resistance genes [erm(A), erm(B), erm(C), ere(A), ere(B), mph(A), mph(B), mph(D), mef(A), and msr(A)] were determined for all 56 (11.1%) isolates with an AZM disk diffusion zone diameter of ≤15 mm. The distribution of AZM ECV MICs was also determined for 186 Shigella isolates with a disk zone diameter of ≥16 mm. Finally, pulsed-field gel electrophoresis (PFGE) was performed on 15 Shigella flexneri isolates with an AZM disk zone diameter of <16 mm from different years and geographic locations. Serotyping the 502 Shigella species isolates revealed that 373 (74%) were S. sonnei, 119 (24%) were S. flexneri, and 10 (2%) were S. boydii Of the 119 Shigella flexneri isolates, 48 (42%) isolates had an AZM disk diffusion zone diameter of ≤15 mm and a MIC of ≥16 µg/ml. With the exception of one isolate, all were positive for the macrolide resistance gene mph(A). S. flexneri PFGE showed four distinct patterns, with patterns I and II presenting with 92.3% genetic similarity. On the other hand, 2 (0.5%) of the 373 S. sonnei isolates had the AZM non-wild-type (NWT) ECV phenotype (those with acquired or mutational resistance), as the AZM MICs were ≥32 µg/ml and the isolates were positive for the mph(A) gene. Overall, our S. flexneri results are in concordance with the CLSI AZM ECV, but isolates with an AZM disk diffusion zone diameter between 14 and 15 mm should be carefully evaluated, as the S. flexneri AZM MIC for NWT isolates may need adjustment to 32 µg/ml. Our data on S. sonnei support that the AZM NWT ECV should be 11 mm for the disk diffusion zone diameter and ≥32 µg/ml for the MICs.

Effects of rhubarb (Rheum ribes L.) syrup on dysenteric diarrhea in children: a randomized, double-blind, placebo-controlled trial

BackgroundRheum ribes L. is a plant native to China, Iran, Turkey, India, and a few other countries. Antidiarrheal activity is considered to be one of its important properties according to various systems of traditional medicine. An increasing rate of bacterial resistance to antibiotics has led to treatment failure in some cases of shigellosis in children, and underlines a need for safe, efficient and valid options. ObjectiveThe purpose of this study is to evaluate the efficacy of R. ribes syrup as a complementary medicine for treatment of shigellosis in children. Design, Setting, Participants and InterventionsThis randomized, double-blind, placebo-controlled trial started with a group of 150 children aged between 12–72 months with suspected Shigella dysentery. R. ribes syrup or placebo syrup was administered to the intervention and control groups, respectively for 5 days. In addition, the standard antibiotic treatment (ceftriaxone for the first 3 days and cefixime syrup for 2 further days) was administered to both groups. Main Outcome MeasuresBody temperature, abdominal pain, need for antipyretics, defecation frequency, stool volume and consistency and microscopic stool examination were recorded as outcome measures. Any observed adverse effects were also recorded. ResultsMean duration of fever and diarrhea in the R. ribes group was significantly lower than that in the placebo group (P = 0.016 and 0.001, respectively). In addition, patients in the R. ribes group showed shorter duration of need for antipyretics and shorter duration of abdominal pain (P = 0.012 and 0.001, respectively). However, there were no significant differences between the two groups regarding the microscopic stool analyses. Furthermore, no adverse effect was reported. ConclusionR. ribes syrup can be recommended as a complementary treatment for children with Shigella dysentery. Trial RegistrationIranian Registry of Clinical Trial: IRCT2014070518356N1.

Shigella infections in children: New insights

Shigellosis , the acute enteric infection caused by bacteria of the genus Shigella , has a worldwide distribution with an estimated annual incidence of 164.7 million cases, of which 163.2 million occur in developing countries, and 1.1 million deaths. Sixty-nine percent of all episodes and 61 percent of all Shigella -related deaths involve children younger than 5 years old. In the United States, 10,000 to 15,000 cases of shigellosis are reported each year. Although usually confined to the colonic mucosa, shigellosis sometimes can cause extraintestinal complications. Recent publications have shed light on the clinical characteristics of Shigella -induced bacteremia, surgical complications, urogenital symptoms, and neurologic manifestations, and on the unique manifestations in the neonatal period. The mainstay of treatment of shigellosis in children is correction of the fluid and electrolyte loss, which often is achieved by the administration of oral rehydration solutions. Appropriate antibiotic therapy shortens the duration of both clinical symptoms and fecal excretion of the pathogen. However, the increasing antimicrobial resistance of shigellae worldwide constitutes a major problem. Regarding the pathophysiology of shigellosis and its complications, recent data not only elucidated the molecular mechanisms involved but also linked manifestations of disease to the interplay of bacterial virulence factors and host responses. The improved understanding of the pathophysiology is hoped to lead to innovative therapeutic approaches against shigellosis and new generations of vaccine candidates.

Hyperimmune bovine colostrum in the treatment of shigellosis in children: a double‐blind, randomized, controlled trial

Immunological approaches have been considered as an alternative therapeutic option for the treatment of enteric infections over the past few years. Hyperimmune bovine colostrum (HBC) is a potentially innovative immunological option in the management of shigellosis together with traditional antibiotic therapy. Children aged 1‐12 y with a history of bloody mucoid diarrhoea of less than 5 d duration were enrolled after their stool specimen was found to be positive for Shigella dysenteriae type 1 antigen by a rapid diagnostic fluorescent antibody staining test. They were randomized to receive either HBC containing very high titres of antibody against S. dysenteriae type 1 antigen or bovine colostrum (BC) without any antibody. The study group received 100ml of HBC three times a day orally for 3 d and control group received BC. Children also received pivmecillinam in a dose of 50mg kg−1 d−1 in four divided doses orally for 5 d. Admission characteristics of the 34 children in the HBC group and 35 in the BC group were comparable. No significant differences were observed in duration of diarrhoea, fever, anorexia, abdominal pain, tenesmus, stool frequency or visible blood in the stool between the groups. Two (6%) children in the study and five (14%) in the control group remained stool culture positive for S. dysenteriae type 1, even after 5 d of sensitive antimicrobial therapy. Conclusion: The results indicate that HBC as an adjuvant is unable to show any beneficial effect in reducing the stool frequency, duration or severity of childhood shigellosis due to S. dysenteriae type 1 infection.

Unusual Cause of Neonatal Septic Shock: Neonatal Shigellosis

Unusual Cause of Neonatal Septic Shock: Neonatal Shigellosis

Comparative Efficacy of Pivmecillinam and Cotrimoxazole in Acute Shigellosis in Children

In a prospective randomized double-blind trial, pivmecillinam was compared with cotrimoxazole (TMP-SMX), both given orally for a period of 5 days, for the treatment of 59 children with shigellosis. 29 patients were treated with pivmecillinam and 30 with cotrimoxazole. 14% of shigella organisms isolated were resistant to pivmecillinam and 21% to TMP-SMX. The diarrhea persisted for a mean (+/- SD) period of 74 +/- 24.8 h in the pivmecillinam-treated patients versus 73.8 +/- 34 h in the TMP-SMX-treated patients. Duration of fever, positive stool culture, visible blood, occult blood, and pus cells in the stools were similar for both treatment groups. Five patients (17%) in the pivmecillinam group and 4 patients (13%) in the cotrimoxazole group fulfilled the clinical criteria that defined treatment failure. One patient (3.4%) in the pivmecillinam group and 2 (6.6%) in the TMP-SMX group evidenced recurrence of the diarrheal symptoms at the follow-up visit. No major drug-related side effects were observed in either group. We concluded that pivmecillinam is equivalent to cotrimoxazole in the treatment of shigellosis in children.

Antibiotics in the management of shigellosis in children: what role for the quinolones?

In the last 20 years, epidemic bacillary dysentery due to Shigella dysenteriae type 1 has become an important cause of serious morbidity and death in children less than 5 years of age in a number of developing countries; in many instances the infecting strains have been resistant to many or all of the usually recommended antibiotics. Moreover, an increasing proportion of Shigella strains of other serotypes isolated in all parts of the world are now resistant to the most commonly used antibiotics. The new fluoroquinolones have been shown to be active against Shigella in vitro and effective for the treatment of shigellosis in adults, but concern about the safety of quinolones has so far prevented the evaluation of these agents for the treatment of shigellosis in young children. Two observations, however, have led a Scientific Working Group of the World Health Organization to suggest that such studies would be appropriate for the following reasons: a one- or two-dose treatment is likely to be effective, and if so the amount of drug given would be far below the doses that have been determined to be toxic in animals; and nalidixic acid, which shares all the toxicity of the fluoroquinolones, is widely recommended--and in some areas routinely used--for the treatment of shigellosis in young children without reports of significant adverse effects. In the Group's view there is an urgent need to perform carefully conducted research to determine the safety and efficacy of fluoroquinolones for the treatment of shigellosis in children.