Antibiotic treatment of acute shigellosis: failure of cefamandole compared with trimethoprim/ sulfamethoxazole and ampicillin.
Intravenously administered ampicillin (AMP), trimethoprim-sulfamethoxazole (TMP-SMX) and cefamandole (CEF) were evaluated in 30 children with shigellosis: 11 children received AMP, 10 TMP-SMX, and 9 CEF for a maximum of five days. Discharge criteria included; afebrile greater than 12 hrs, less than 9 stools/day, absence of seizures, and adequate oral intake. AMP or TMP-SMX patients required significantly fewer median days to meet discharge criteria than those who received CEF. AMP and TMP-SMX patients had fewer median days with fever (one day each) compared with CEF (five days). On day five, 7 of 8 CEF, 3 of 10 AMP and 2 of 9 TMP-SMX treated patients remained culture positive. Inhibitory concentrations against all Shigella isolates from CEF patients all were less than or equal to 0.4 microgram CEF/ml. Intravenous TMP-SMX was equivalent to AMP in treatment of children with shigellosis, while CEF was ineffective despite in vitro activity. Clinical and bacteriologic responses were achieved with AMP and TMP-SMX in the majority of patients with less than 5 days of intravenous therapy.
D000667:Ampicillin / Q000627:therapeutic use*; D002435:Cefamandole / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D004341:Drug Evaluation; D004405:Dysentery, Bacillary / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011897:Random Allocation; D013420:Sulfamethoxazole / Q000009:adverse effects / Q000627:therapeutic use*; D014295:Trimethoprim / Q000009:adverse effects / Q000627:therapeutic use*
D002511:Cephalosporins; D004338:Drug Combinations; D002435:Cefamandole; D000667:Ampicillin; D014295:Trimethoprim; D013420:Sulfamethoxazole