title: Comparison of single-dose treatment with norfloxacin and standard 5-day treatment with trimethoprim-sulfamethoxazole for acute shigellosis in adults.
abstract: Shigellae have been shown to be highly susceptible to new quinolone agents, with average MICs for 90% of isolates of less than 0.1 microgram/ml. Because these agents also reach high concentrations in the stool after a single dose, the effectiveness of a single 800-mg dose of norfloxacin and of 5-day treatment with trimethoprim-sulfamethoxazole (TMP-SMX) were compared in a randomized trial. Patients with clinical dysentery received one of these treatment regimens, and clinical data and follow-up culture results were analyzed for patients whose stool culture on presentation grew shigellae. When 55 patients with shigellosis (26 treated with TMP-SMX, 29 treated with norfloxacin) whose bacterial isolates were susceptible to the antibiotic given were compared by treatment group, no significant differences were seen in days of illness (mean, 2.5 +/- 0.65 days with TMP-SMX and 2.0 +/- 0.47 days with norfloxacin; P = 0.200) or number of unformed stools after starting treatment (mean, 9.7 +/- 2.37 stools with TMP-SMX and 7.6 +/- 3.19 stools with norfloxacin; P = 0.312). Resistance in vitro to TMP-SMX was seen in 15% of Shigella isolates, whereas none was resistant to norfloxacin. Bacteriologic failure was found in 1 patient among 24 receiving TMP-SMX and in none of 25 patients receiving norfloxacin. One single dose of norfloxacin was as effective as 5 days of treatment with TMP-SMX in these adults with shigellosis.
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: E
authors.initials: E
authors.lastname: Gotuzzo
authors.forename: R A
authors.initials: RA
authors.lastname: Oberhelman
authors.forename: C
authors.initials: C
authors.lastname: Maguiña
authors.forename: S J
authors.initials: SJ
authors.lastname: Berry
authors.forename: A
authors.initials: A
authors.lastname: Yi
authors.forename: M
authors.initials: M
authors.lastname: Guzman
authors.forename: R
authors.initials: R
authors.lastname: Ruiz
authors.forename: R
authors.initials: R
authors.lastname: Leon-Barua
authors.forename: R B
authors.initials: RB
authors.lastname: Sack
mesh_terms: D000328:Adult; D002986:Clinical Trials as Topic; D003967:Diarrhea / Q000382:microbiology; D004338:Drug Combinations / Q000627:therapeutic use; D004405:Dysentery, Bacillary / Q000188:drug therapy* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D006801:Humans; D009643:Norfloxacin / Q000627:therapeutic use*; D011897:Random Allocation; D013420:Sulfamethoxazole / Q000627:therapeutic use*; D014295:Trimethoprim / Q000627:therapeutic use*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
chemical_list: D004338:Drug Combinations; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D014295:Trimethoprim; D013420:Sulfamethoxazole; D009643:Norfloxacin