Guidelines for the treatment of dysentery (shigellosis): a systematic review of the evidence

Abstract

Background: Shigella remains the primary cause of diarrhoea in paediatric patients worldwide and accounts for up to 40,000 deaths per year. Current guidelines for the treatment of shigellosis are based on data which are over a decade old. In an era of increasing antimicrobial resistance, an updated review of the appropriate empirical therapy for shigellosis in children is necessary, taking into account susceptibility patterns, cost and the risk of adverse events. Methods: A systematic review of the current published literature on the treatment of shigella dysentery was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: The initial search produced 131 results, of which nine studies met the inclusion criteria. The quality of the studies was assessed as per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. International guidelines were also reviewed. There is a lack of current research regarding the clinical treatment of shigellosis in paediatric and adult patients, despite rising antimicrobial resistance worldwide. In particular, there is a lack of studies assessing the non-susceptibility of community-acquired strains, with almost all published research pertaining to microbiological data from hospital-based settings. Discussion: Current WHO guidelines support the use of fluoroquinolones (first-line), β-lactams (second-line) and cephalosporins (second-line) which accords with currently available evidence and other international guidelines, and there is no strong evidence for changing this guidance. Azithromycin is appropriate as a second-line therapy in regions where the rate of non-susceptibility of ciprofloxacin is known to be high, and research suggests that, from a cardiac point of view, azithromycin is safer than other macrolide antibiotics. Cefixime is also a reasonable alternative, although its use must be weighed against the risk of dissemination of extended-spectrum β-lactamase-producing organisms.

A New Phage Cocktail Against Multidrug, ESBL-Producer Isolates of Shigella sonnei and Shigella flexneri with Highly Efficient Bacteriolytic Activity

“…Williams and Berkley reported that resistance to the third generation of the cephalosporins due to increased number of the ESBL-producing bacteria has been increasingly prevalent in Asia, and suggested monitoring plans for such strains. 31 The relatively high rate of ESBL isolates in this study (59% and 46.1% for S. sonnei and S. flexneri, respectively) indicates a significant increase in the population of these superbugs and calls for urgent actions in developing new efficient alternatives for rapid detection, monitoring, and control/treatment strategies.…”

Study of Shigella flexneri via traditional-bacterial isolation, PCR-sequencing identification, and phylogenetic tree analysis in Al-Diwaniyah City, Iraq

“…Shigella flexneri is a bacterium characterized by Gramnegative staining and its behaviour as a facultative anaerobe which is a member of the family, Enterobacteriaceae (Jin et al, 2002;Wei et al, 2003). Failure to introduce sufficient management of the infection may add some detrimental incidents that might prevent required recovery within normal times or might lead to lose life (Williams and Berkley, 2018). The disease initiated by these bacteria is well known for its million-based morbidity and mortality occurrence especially in children in poor-health system countries (Kotloff et al, 1999).The results in the current work revealed the presence of S.flexneri in the samples using the regular Lab techniques specific for the isolation of bacteria.…”

“…The epithelial layers of the colon and rectum are the main targets for these bacteria leading to acute mucosal inflammation, severe tissue damage, abscess formation, ulceration, watery diarrhea, severe abdominal pain, and dysentery (Bennish, 1991;Taneja and Mewara, 2016). Lack of useful treatment may lead to the development of certain secondary health events such as septicemia, hemolytic uremic syndrome, pneumonia, rectal prolapse, arthralgia, seizures, toxic megacolon, intestinal perforation, electrolyte imbalance, and leukemoid reactions (Williams and Berkley, 2018).This disease is responsible of 1.1 million and over 164 million cases each year of mortalities and morbidities respectively; however, this disease attacks mostly children in countries with poor-health systems (Kotloff et al, 1999). The developing countries are known for the S. flexneri serotypes of 1b, 2a, 3a, 4a and 6; however, industrialized countries are known for the presence of 2a serotype in their patients (Kotloff et al, 1999).…”

Shigella-mediated immunosuppression in the human gut: subversion extends from innate to adaptive immune responses

“…Preventing shigellosis remains more than ever a public health priority. [98][99][100] Indeed, as recently reviewed, 101 there is a growing appreciation for the role of vaccines in confronting the problem of antimicrobial resistance, which includes the alarming emergence of multi-drug resistant Shigella strains. 98…”