Antibiotics for the treatment of dysentery in children

Traa, Beatrix S; Walker, Christa L. Fischer; Munos, Melinda; Black, Robert E.

doi:10.1093/ije/dyq024

Cited by 71 publications

(61 citation statements)

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“…Fluoroquinolones, ceftriaxone and pivmecillinam are the antibiotics currently recommended by the World Health Organization for the treatment of dysentery in children, as these drugs are effective at reducing mortality caused by Shigella spp. (Traa et al, 2010). These drugs are also effective among immunocompromised children, including neonatal patients, suffering from infections caused by multi-drugresistant strains of Salmonella and Shigella spp.…”

Section: Introductionmentioning

confidence: 99%

Genetic characteristics and changing antimicrobial resistance among Shigella spp. isolated from hospitalized diarrhoeal patients in Kolkata, India

Ghosh

Pazhani

Chowdhury

et al. 2011

Journal of Medical Microbiology

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To study the prevalence pattern and trends in the phenotypic and genetic characteristics of shigellae, we tested 212 isolates isolated from diarrhoeal patients admitted to the Infectious Diseases Hospital, Kolkata, India, from November 2007 to October 2010. Prevalence of Shigella spp. was higher in the .5 years age group (69 %) than in children in the ,5 years age group (31 %). Serotypes 2a, 3a and untypable isolates of Shigella flexneri were frequently detected. An increase in the isolation of Shigella sonnei (15 %) is a novel trend in this region. Fluoroquinolone resistance among S. flexneri serotypes 2a, 3a and other serogroups of shigellae is another evolving trend. The set gene was exclusively present in S. flexneri 2a, and the sen gene was detected in all serogroups. PFGE revealed the grouping of S. flexneri isolates according to their serotypes with approximately 80-100 % similarity, whilst Shigella dysenteriae type 2 and S. sonnei were clonal in nature. There was no demarcation in the prevalence of serotypes, antimicrobial resistance or clonality between the two age groups. INTRODUCTIONShigellosis remains a considerable public-health problem in many parts of the world. About 125 million cases of Shigella infection occur annually in Asia, of which approximately 14 000 are fatal (Bardhan et al., 2010). The distribution of serogroups of Shigella spp. differs from country to country: Shigella flexneri, Shigella sonnei and Shigella boydii serogroups are predominant in developing countries, whilst S. sonnei is frequently reported in industrialized countries. Prevalence of Shigella dysenteriae is mostly reported from South Asia and sub-Saharan Africa (Kotloff et al., 1999). Unlike other acute diarrhoeal illnesses that require adequate fluid replacement by either oral or intravenous rehydration, shigellosis needs antimicrobial therapy to reduce the duration of the illness and to prevent transmission to close contacts. Shigella spp. have developed perpetual resistance to ampicillin and trimethoprimsulfamethoxazole, which have been used in paediatric cases during the past two decades. Fluoroquinolones, ceftriaxone and pivmecillinam are the antibiotics currently recommended by the World Health Organization for the treatment of dysentery in children, as these drugs are effective at reducing mortality caused by Shigella spp. (Traa et al., 2010). These drugs are also effective among immunocompromised children, including neonatal patients, suffering from infections caused by multi-drugresistant strains of Salmonella and Shigella spp. (Leibovitz, 2006). The use of antimicrobials for the treatment of shigellosis varies from country to country. Pivmecillinam is not the drug of choice for the treatment of diarrhoea in many countries, but is being used in Bangladesh (Rahman et al., 2007). Ceftriaxone is an ideal drug for the treatment of shigellosis in regions where fluoroquinolone resistance is common. The American Academy of Pediatrics and the Infectious Diseases Society of America recommend azithromycin as an alternativ...

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Section: Introductionmentioning

confidence: 99%

Genetic characteristics and changing antimicrobial resistance among Shigella spp. isolated from hospitalized diarrhoeal patients in Kolkata, India

Ghosh

Pazhani

Chowdhury

et al. 2011

Journal of Medical Microbiology

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“…Mathematical modeling data shows that >99% of the deaths due to dysentery can be averted by use of appropriate antibiotics [18]. We however have no data to comment on whether the children with dysentery who died, received antibiotic treatment or not.…”

Section: Discussionmentioning

confidence: 98%

Predictors of diarrheal mortality and patterns of caregiver health seeking behavior in in Karachi, Pakistan

Qamar¹,

Zaman²,

Quadri³

et al. 2016

Journal of Global Health

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Predictors of diarrheal mortality and patterns of caregiver health seeking behavior in in Karachi, PakistanBackground Pakistan is unfortunately among the five countries that contributed to the most deaths due to diarrhea and pneumonia in 2010. To explore factors associated with diarrheal deaths we assessed care-seeking behavior and other predictors of diarrhea-related mortality in children in selected low-income peri-urban communities of Karachi, Pakistan.

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“…12 Most strains of Shigella and enteroinvasive E. coli remain susceptible to ciprofloxacin. 13 The unresolved question is how to treat bloody diarrhoea due to enterohaemorrhagic E. coli (EHEC). There are significant grounds for thinking that treatment of EHEC with antibiotics leads to the release of verocytotoxin which precipitates haemolytic uraemic syndrome (HUS).…”

Section: Managementmentioning

confidence: 99%

Diarrhoeal disease

Kelly

2011

Clinical Medicine

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489 CME Tropical medicineestuarine waters of the Ganges delta acquired a cassette of virulence genes on one or more plasmids and evolved into a major human pathogen which has unleashed seven pandemics and spread to all continents. 7,8 Its power to kill spectacularly in a matter of hours has inspired considerable fear, and even novels! The pathophysiology is still not completely understood (in particular, the interaction between toxins and the enteric nervous system), but several points can be made (Fig 1 illustrates the physiology of cholera):1 The mucosal architecture of the small intestine, in particular the epithelium, remains intact. 2 Large numbers of bacteria are required to induce disease. Each bacterium liberates a finite quantity of cholera toxin which induces irreversible changes in a number of epithelial cells. The consequence is that the infectious dose is high -about 10 9 bacteria are required to produce clinical cholera in a healthy person. 9 3 The greater the amount of toxin synthesised in the gut, the greater the severity of clinical illness. The toxin induces cyclic adenosine monophosphate synthesis in the cell, leading to changes in the balance of water and salt transport so that the small intestine becomes a net secretor of water and electrolytes. This overwhelms the reserve absorptive capacity of the colon and unabsorbed water reaches the rectum. 4 When a cell is exposed to cholera toxin, although it is morphologically normal, its chloride secretion is irreversibly turned on. This does not prevent the cell from absorbing sodium (Na) through the Na-glucose co-transporter. By providing extra substrate for the Na-glucose cotransporter, the re-uptake of Na (then water) becomes possible. 5 The faecal losses of electrolytes are relatively constant, so cholera leads fairly predictably to a hypokalaemic metabolic acidosis in addition to severe volume depletion. 6 Once the toxin is removed, normal epithelial regeneration replaces the population of cells which have been physiologically reprogrammed with a new population of enterocytes which secrete water and electrolytes normally.Management. The management of cholera exploits these principles:1 Oral rehydration solution (ORS) is used to stimulate Na-glucose cotransport and increase uptake of water and electrolytes into the small intestine. The ORS must contain potassium, and ideally bicarbonate CME Tropical medicineor citrate to help compensate for the loss of bicarbonate in stool. 2 Antibiotics are useful to reduce both the amount of toxin being generated and stool losses, and to allow the repopulation of the epithelial compartment with normal cells, thus shortening the clinical illness.The International Centre for Diarrhoeal Disease Research in Bangladesh has extensive experience of managing cholera. Using the guiding principles listed above, it has managed to reduce the mortality of cholera to well below 1%. The addition of zinc has allowed a further reduction in duration of illness. 3,10,11 Oral rehydration therapy is the mainstay of treatment, wi...

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Antibiotics for the treatment of dysentery in children

Cited by 71 publications

References 14 publications

Genetic characteristics and changing antimicrobial resistance among Shigella spp. isolated from hospitalized diarrhoeal patients in Kolkata, India

Genetic characteristics and changing antimicrobial resistance among Shigella spp. isolated from hospitalized diarrhoeal patients in Kolkata, India

Predictors of diarrheal mortality and patterns of caregiver health seeking behavior in in Karachi, Pakistan

Diarrhoeal disease

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