Comparative efficacy of nalidixic acid and ampicillin for severe shigellosis

A severe epidemic of dysentery began late in 1979 in northeast Zaire and spread to Rwanda, Burundi, and Tanzania. The epidemic strain is a multiply resistant Shigella dysenteriae type 1, which acquired resistance against trimethoprim and more recently against nalidixic acid in the course of the epidemic. A comparative open trial in Rwandan adults with Shiga dysentery involved 18 patients treated with norfloxacin at 400 mg twice daily and 12 patients treated with nalidixic acid at 1 g three times daily for 5 days. All isolates showed in vitro susceptibility to both drugs. Though norfloxacin eliminated Shigella organisms from stools more rapidly than nalidixic acid, its clinical superiority did not reach the level of significance. Norfloxacin is a promising drug and is more effective than nalidixic acid in the treatment of multiresistant shigellosis.

Section: Norfloxacin Versus Nalidixic Acid For Dysenterymentioning

confidence: 99%

Comparison of norfloxacin and nalidixic acid for treatment of dysentery caused by Shigella dysenteriae type 1 in adults

Rogerie¹,

Ott²,

Vandepitte³

et al. 1986

“…It should be pointed out, however, that in several recent reports (8,13,15) In previous investigations, the quinoline drugs oxolinic and nalidixic acids, to which norfloxa-VOL. 23,1983 on May 12, 2018 by guest http://aac.asm.org/ Downloaded from cin is structurally related, were found to be active both in vitro (6,16) and in vivo (10,17) against antibiotic-resistant shigellae. Furthermore, the efficacy of oxolinic acid in treating chronic Shigella carriers has been reported (32 Although the development of resistance to nalidixic and oxolinic acids during treatment of urinary tract infections has been shown (1, 7), it is believed that the quinolines still have a significant advantage over other commonly used agents in that resistance appears not to be mediated by R factors (1,5), a property which in theory should greatly limit the spread of resistant strains.…”

mentioning

confidence: 99%

In vitro antibacterial activity of norfloxacin (MK-0366, AM-715) and other agents against gastrointestinal tract pathogens

Shungu¹,

Weinberg²,

Gadebusch³

1983

A comparison was made of the in vitro activities of norfloxacin and of nine other orally administered antibacterial agents against 180 clinical isolates representing the bacterial species most frequently implicated in infections of the gastrointestinal tract in humans. The 90% minimal inhibitory concentrations showed norfloxacin to be 4, 15, 4, 17, 17, 17, and 33 times more active than the next best compound tested against Campylobacter fetus subsp. jejuni, Escherichia coli, Salmonella spp., Shigella spp., Vibrio cholerae, Vibrio parahaemolyticus, and Yersinia enterocolitica, respectively, with an overall 90% minimal inhibitory concentration of less than or equal to 0.5 micrograms/ml. Norfloxacin was least active against Clostridium difficile (90% minimal inhibitory concentration, 128 micrograms/ml). These results should encourage further evaluation of norfloxacin as a potential chemotherapeutic agent in the treatment of enteric bacterial infections for which antibiotic therapy is indicated.

“…Cinoxacin is a newer quinoline drug and is as yet unlicensed for use. Isolated in vivo studies with the quinoline drugs (2,6) and with the trimethoprim-sulfamethoxazole combination (4,8,10) show adequate clinical response when compared to Am or furazolidone.…”

mentioning

confidence: 99%

Antimicrobial Susceptibilities of Shigellae Isolated in Houston, Texas, in 1974

Byers

DuPont

Goldschmidt

1976

One hundred seventy-three strains of shigellae (113 Shigella sonnei, 56 S. flexneri, and four others) isolated in Houston during 1974 were tested for susceptibility to commonly used and newer antimicrobial agents. Forty-five percent of S. sonnei strains were susceptible to ampicillin, whereas 93% of S. flexneri strains were susceptible to that agent. S. sonnei and S. flexneri strains were equally susceptible to tetracycline (35 and 33%, respectively). All 173 strains were uniformly susceptible to quinoline drugs (cinoxacin, oxolinic acid, and nalidixic acid) and to trimethoprim-sulfamethoxazole. This study supports recent suggestions that the initial therapy of bacillary dysentery no longer should be ampicillin or tetracycline. It remains for field testing to determine whether quinoline agents or trimethoprim-sulfamethoxazole will be the treatment of choice.Resistance of shigellae to a number of commonly used antimicrobial agents has prompted a search for new effective drugs in the treatment of shigellosis. Ampicillin (Am) has been considered the drug of choice for pediatric bacillary dysentery. Adults with shigellosis have generally been treated with either Am or tetracycline (Te). In light of recent reports of rapidly emerging multiple-resistant shigellae isolated in the United States, the use of Am and Te as primary drugs must be questioned (5, 11). Strains commonly isolated today reveal resistance to one or more of the following antimicrobial agents: Am, Te, streptomycin (Sm), chloramphenicol (C), and sulfonamides (3).The present study was designed to determine the in vitro antimicrobial susceptibility patterns of shigella strains recently isolated in Houston, Tex. We were interested in documenting the frequency of resistance to commonly used antimicrobial agents, but more importantly in determining the susceptibilities to newer antimicrobial agents, the quinoline drugs and trimethoprim-sulfamethoxazole.MATERIALS AND METHODS Bacterial strains. One hundred seventy-three isolates of shigellae were studied. The strains were obtained and identified by the Houston City Health Department during 1974. Each culture was a singlecolony primary isolate from a fecal specimen and/ or a pure culture sent to the Health Department for evaluation. Storage was less than 12 months at 4 C or at room temperature. All strains were representative isolates from numerous individuals in Houston, and multiple strains from common source outbreaks or individual households were excluded from study. Strains were streaked by us on MacConkey agar (Difco) for isolations before inclusion in the study. In total, 113 strains of Shigella sonnei, 56 strains of S. flexneri, 3 strains of S. dysenteriae, and 1 strain of S. boydii were evaluated for their antimicrobial susceptibility patterns. Staphylococcus aureus (ATCC 25923) and Escherichia coli (ATCC 25922) were obtained in lyophilized form from Bactrol Discs, set A, Difco Laboratories, Detroit, Mich., and were included as controls in the susceptibility testing.Antimicrobial agent susceptibility ...