What is the role of medication in the treatment of shigellosis?

Updated: Aug 20, 2021
  • Author: Heba Rashid Ashraf, MD; Chief Editor: BS Anand, MD  more...
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Answer

Shigella infection produces a self-limited diarrheal illness that lasts 5-7 days and may not require antibiotics in individuals who are otherwise healthy. [3] However, for public health reasons, most experts recommend treating any person whose stool culture is positive for Shigella species. Moreover, antibiotics have been shown to decrease the duration of fever and diarrhea by about 2 days. The shorter duration of shedding with antibiotic therapy can reduce the risk of person-to-person spread. Antibiotic treatment is definitely recommended for infirm or older patients, malnourished children, patients infected with human immunodeficiency virus (HIV) infection, food handlers, health care workers, and children in day care centers. [43]  However, antibiotic-resistant strains of Shigella have emerged, posing therapeutic challenges. [20, 44]

Ampicillin was widely used in the past but is no longer an effective empiric treatment in the United States because of antibiotic resistance. [45] In fact, antibiotic resistance to Shigella species is widespread and increasing worldwide. Thus, antibiotic susceptibility testing is essential for the management of patients with suspected Shigella infection.

At present, ciprofloxacin, azithromycin, and ceftriaxone are the mainstays of treatment for shigellosis. However, in some regions increasing evidence exists of decreased susceptibility or full resistance to these agents. [5, 46, 47]

In a study comprising 90 patients with shigellosis from 2008 to 2013 who had acquired Shigella as traveler's diarrhea or domestically acquired diarrhea, Toro et al detected the highest resistance for trimethoprim/sulfamethoxazole (81.8%), followed by ampicillin (37.8%) and ciprofloxacin (23.3%). [48]

Given the widespread resistance to ciprofloxacin as well as trimethoprim-sulfamethoxazole and azithromycin, a third-generation cephalosporin is appropriate empiric therapy in the setting of acute illness. [43, 49] The treatment of choice for HIV-infected patients is a quinolone for 5 days.


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