[Ciprofloxacin after clinical failure of beta-lactam antibiotics in children with salmonellosis].
BACKGROUND
Children with enteric fever or severe salmonella infections are usually treated with beta-lactam antibiotics, particularly ceftriaxone. Due to their poor penetration into cells, beta-lactam antibiotics, even if active in vitro, are sometimes clinically ineffective because they cannot reach the intracellular sites of Salmonella multiplication.


OBJECTIVE
To evaluate in a retrospective study usefulness, efficacy and safety of oral ciprofloxacin in patients with severe salmonellosis and clinical failure of ceftriaxone or beta-lactam antibiotics.


METHODS
From July 1, 1995 to 2000, the bacteriology laboratory of a French pediatric hospital had identified 215 patients aged between 1 month and 15 years with positive blood or stools for Salmonella sp, 113 of them requiring hospitalization due to their clinical symptoms. Three were excluded for sickle-cell disease or poor nutritional status. None of the 110 strains (including 4 S. typhi, 51 S. typhimurium, 25 S. enteritidis, 6 S. hadar and 5 S. heidelberg) isolated was resistant to ceftriaxone or ciprofloxacin. Forty-one of the 110 strains (37.3%) produced a beta-lactamase. Twelve patients had a rapid recovery without antibiotic treatment, and 98 (mean age 3.9 years) were given antibiotics (ceftriaxone in 91 and amoxicillin in 7) for dysentery (43%), shock (15%) or persistent high fever and severe diarrhea (42%).


RESULTS
In 72 children (mean age = 3.6 years) ceftriaxone treatment (amoxicillin in 5) for 5 or 7 days was rapidly effective: apyrexia was obtained in 1.5 day after the start of treatment and the number of stools per day was 4 or less in 2.2 days. Two to 3 weeks after clinical recovery, asymptomatic carriage was present in 22/38 patients. In the 26 other patients ceftriaxone (amoxicillin in 2) treatment was clinically ineffective, despite good in vitro activity, and was switch for oral ciprofloxacin (20 mg kg(-1) d(-1), 5 days) after 2 to 7 days of lasted fever and/or severe diarrhea. Clinical improvement with ciprofloxacin was obtained in less than 48 h. The strains involved in these 26 patients included the 4 S. typhi and 15 S. typhimurium (P < 0.05), 13/15 (P < 0.01) producing beta-lactamase. Asymptomatic carriage was found in 5/22 patients (P < 0.05) after recovery. None of the patient treated with ciprofloxacin had side effect.


CONCLUSIONS
In severe salmonellosis, the clinical failure of treatment with ceftriaxone is not rare, particularly in S. typhimurium producing beta-lactamase infection and short treatment with oral ciprofloxacin is safe and allows to obtain a rapid recovery.
Moulin
F
F
Hôpital Saint-Vincent-de-Paul, AP-HP, 82, avenue Denfert-Rochereau, 75014 Paris, France.
Sauvé-Martin
H
H
Marc
E
E
Lorrot
Mathie M
MM
Soulier
M
M
Ravilly
S
S
Raymond
J
J
Gendrel
D
D
D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012480:Salmonella Infections / Q000188:drug therapy*; D016896:Treatment Outcome; D047090:beta-Lactams
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D047090:beta-Lactams; D002939:Ciprofloxacin