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Evidence summaries

Antibiotic Therapy for Shigella Dysentery

Antibiotics appear to reduce the duration of Shigella dysentery. There is insufficient evidence to suggest which antibiotics are superior. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 16 studies with a total of 1 748 subjects. One three-arm study compared furazolidone, cotrimoxazole and no drug. The other three-arm study compared ceftriaxone, ampicillin and placebo. Six trials compared fluoroquinolones (3 nalidixic acid, 3 ciprofloxacin) with beta-lactams (5 ampicillin or derivatives, 1 ceftriaxone). Two trials compared fluoroquinolones with macrolides (ciprofloxacin with azithromycin). Two trials compared cotrimoxazole with beta-lactams. One study compared cotrimoxazole with norfloxacin, one furazolidone with nalidixic acid and one oral gentamicin with nalidixic acid. One was a four-armed trial: the first three had different types of sulphonamides and the fourth arm was tetracycline.

In comparisons of antibiotics versus no drug or placebo (two trials), fewer patients in the antibiotic group had diarrhoea at follow up (for furazolidone versus no treatment RR 0.21, 95% CI 0.09 to 0.48, 73 participants; and for cotrimoxazole versus no treatment RR 0.30, 95% CI 0.15 to 0.59; 76 participants). In a comparison of intravenous ceftriaxone (n=64) and intravenous ampicillin (n=60) with placebo (n=30), there was no difference detected in time to diarrhoea resolution, fever resolution, time to resolution of blood in the stools, or adverse events.

In comparisons of fluoroquinolones versus beta-lactams (6 trials, 686 participants), in trials where 90% or more of included patients were confirmed with Shigella, beta-lactams were more effective than fluoroquinolones (RR 4.68, 95% CI 1.74 to 12.59; 257 children, 2 trials); in the four trials with less than 90% confirmed Shigella positive patients the results showed no obvious pattern

In other head-to-head drug comparisons, no major difference between the antibiotic groups could be detected in bacteriological failure, time to cessation of diarrhoea, fever or blood in the stools or adverse events.

Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals).

References

  • Prince Christopher RH, David KV, John SM, Sankarapandian V. Antibiotic therapy for Shigella dysentery. Cochrane Database Syst Rev 2010 Jan 20;(1):CD006784. [PubMed]

Primary/Secondary Keywords