shigellosis relapse

BACKGROUND: Although the recommended standard course of therapy for shigellosis is 5 days of oral ampicillin or trimethoprim-sulfamethoxazole therapy, successful outcome has been reported in adults treated with abbreviated courses of antibiotics. The purpose of this study was to compare short course (2-day) vs. 5-day therapy with cefixime for treatment of diarrheal disease caused by Shigella sonnei in children. METHODS: This was a prospective, randomized, double blind, placebo-controlled study...

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...

To compare the efficacy of oral gentamicin with nalidixic acid in the treatment of acute shigellosis, we studied, in a double blind-trial, 79 comparable children with bloody diarrhoea of less than 72 h duration. Of them Shigella spp. were isolated in 71 patients. Patients were randomly assigned to receive either gentamicin 30 mg/kg/day or nalidixic acid 60 mg/kg/day, both given orally in four equal doses for 5 days. Stool frequency differed significantly between the groups from day two until completion of the study...

To evaluate a more economical regimen for severe shigella dysentery, treatment with single-dose (SD) ampicillin (100 mg/kg) was compared in a randomized trial with results obtained in a conventional five-day (100 mg/kg per 24 hr) multiple-dose (MD) course. Clinical relapse occurred in one of 23 SD children, no SD or MD adults, and none of 18 MD children. Bacteriologic failures were observed in six of 26 adults compared with one of 24 MD adults (P = 0.05). Four of 10 SD children younger than four years of age failed bacteriologically, compared with one MD child...

A severe outbreak of Clostridium difficile antibiotic-associated diarrhoea (AAD) in an orthopaedic surgical unit is reported. Thirty-seven cases and eight relapses were observed. The 45 related strains together with another 13 strains of C. difficile isolated during the same period in other wards of the same hospital were typed by detection of cytotoxin production, determination of sorbitol fermentation and serogrouping by agglutination with six rabbit antisera defining the serogroups A, B, C, D, F and G. All the strains from the outbreak belonged to serogroup C, were toxigenic and fermented sorbitol...

Acute infectious diarrhoea is a widespread cause of morbidity and mortality. Some of the major diarrhoeal diseases are cholera, typhoid fever, shigellosis (bacillary dysentery), salmonellosis, "travellers' diarrhoea", and giardiasis These diseases can be avoided with proper education, sanitation, and hygiene. However, the majority of these diseases occur most frequently in areas of the world where political and social upheaval, poverty, overcrowding, and a lack of education prevail. Although vaccines are available for some of the diseases, they are not completely effective...

Increasing antimicrobial resistance of enteric pathogens represents a significant barrier to therapy for bacterial enteritis and, to a lesser extent, typhoid fever. Poor study design limits the value of many of the clinical trials that suggest drug efficacy. Studies are often not placebo-controlled, randomized, or blind comparative trials; clinical criteria for response are frequently not stated; and the numbers of subjects are small. Among the known therapeutic principles for choosing drugs for enteric infections is that the agent be active in vitro against the isolate, that for treating infections due to invasive pathogens both lumenal and tissue levels be adequate, that drugs with good enterohepatic circulation may be especially well suited for the treatment of infections due to noninvasive pathogens, and that drugs active intracellularly may have particular value in therapy for typhoid, especially in reducing the relapse rate...

Shigella sp. is known to be an important cause of diarrhea in homosexual men, although chronic infection is infrequently recognized. We describe recurrent and relapsing symptomatic infection due to Shigella flexneri in a human immunodeficiency virus-infected homosexual man subsequently developed acquired immunodeficiency syndrome. Patients with acquired immunodeficiency syndrome may be prone to developing chronic shigellosis because of impaired intestinal cell-mediated immunity.

Sixty patients with enterocolitis (36 men, 24 females), mean age thirty seven (12 to 84) have been treated with new quinolones. Two groups have been constituted. First group included patients without bacteremia despite enterocolitis. Among them, 9 patients suffered from shigellosis (8 S. flexneri, 1 S. sonnei). Twenty-two patients had a minor salmonellosis (13 S. typhimurium, 4 S. enteritidis, 1 S. blockley, 1 S. Virchow, 1 S. london, 1 S. baildon, 1 S. C2 group). Patients in the second group underwent a septicemic salmonellosis (18 S...

In a prospective randomized open study, ceftriaxone, 50 mg/kg per day, was compared with ampicillin, 100 mg/kg per day, both given for a period of 5 days, for the treatment of 40 children whose mean (+/- SD) age was 4.5 +/- 3.2 years and who had severe dysentery caused by Shigella organisms. Twenty patients were treated with ceftriaxone and 20 with ampicillin. Both drugs were initially given intravenously for a period of 1 to 2 days and were continued intramuscularly, in the case of ceftriaxone, or orally, in the patients receiving ampicillin...

For the 2-year period 1989-1990, 16 states reported 26 outbreaks due to water intended for drinking; an estimated total of 4,288 persons became ill in these outbreaks. Giardia lamblia was implicated as the etiologic agent for seven of the 12 outbreaks in which an agent was identified. The outbreaks of giardiasis were all associated with ingestion of unfiltered surface water or surface-influenced groundwater. An outbreak with four deaths was attributed to Escherichia coli O157:H7, the only bacterial pathogen implicated in any of the outbreak investigations...