TY - JOUR
T1 - A randomized, double-blind study comparing cefixime and trimethoprim-sulfamethoxazole in the treatment of childhood shigellosis
AU - Ashkenazi, S.
AU - Amir, J.
AU - Waisman, Y.
AU - Rachmel, A.
AU - Garty, B. Z.
AU - Samra, Z.
AU - Varsano, I.
AU - Nitzan, M.
N1 - Funding Information:
Appropriate antibiotic therapy for shigellosis shortens the duration of fever, diarrhea, and shedding of the organism in stools, and probably also reduces the incidence of lethal complications. 1-3 However, because of the increasing antibiotic resistance of Shigella, 46 choosing the appropriate antibiotic agent is problematic, especially in children. Trimethoprim-sulfamethoxazole is currently the recommended Supported by grants from USA-Israel Binational Science Foundation (No. 90-00017) and Teva Inc., Israel. Presented in part at the 18th International Congress of Chemotherapy, Stockholm, Sweden, June 1993. Submitted for publication April 14, 1993; accepted July 7, 1993. Reprint requests: Shai Ashkenazi, MD, Pediatric Infectious Diseases, PO Box 8145, Petah Tiqva 49 181, Israel. Copyright | 1993 by Mosby-Year Book, Inc. 0022-3476/93/$1.00 + .10 9/25/49883 empiric therapy for suspected shigellosis.1, 7 Resistance to this agent and to ampicillin has been reported worldwide. 5' 6 A study in Bangladesh found that nalidixic acid is effective, s but resistance to the drug has been reported. 4 The new qni-nolones, such as ciprofloxacin or ofloxacin, are efficacious but are not approved for use in children because they dam-
PY - 1993/11
Y1 - 1993/11
N2 - We compared the clinical and bacteriologic response of 5-day treatment withcefixime, 8 mg/kg per day, with the response to trimethoprim-sulfamethoxazole (TMP-SMX), 10-50 mg/kg per day, the currently recommended therapy. Of the assessable children with acute, culture-proven shigellosis, 38 received cefixime and 39 received TMP-SMX. Pretreatment data on the two study groups were similar. In the first group, all isolates were susceptible to cefixime; in the TMP-SMX group, 32 isolates were resistant and 7 were susceptible to TMP-SMX. Clinical response (day 5) showed cure, improvement, and failure in 89%, 8%, and 3%, respectively, of the cefixime group, and in 25%, 44%, and 31%, respectively, of the TMP-SMX-resistant group (p<0.001). Bacteriologic cure (day 3) occurred in 78% and 23% of the cefixime and TMP-SMX-resistant groups, respectively (p<0.001). Clinical or bacteriologic relapse (day 12) was infrequent in both groups. The response to treatment of the cefixime and the TMP-SMX-susceptible groups was similar. No significant side effects were noted. We conclude that cefixime is superior to TMP-SMX in the treatment of suspected shigellosis in areas with a high rate of resistance to TMP-SMX.
AB - We compared the clinical and bacteriologic response of 5-day treatment withcefixime, 8 mg/kg per day, with the response to trimethoprim-sulfamethoxazole (TMP-SMX), 10-50 mg/kg per day, the currently recommended therapy. Of the assessable children with acute, culture-proven shigellosis, 38 received cefixime and 39 received TMP-SMX. Pretreatment data on the two study groups were similar. In the first group, all isolates were susceptible to cefixime; in the TMP-SMX group, 32 isolates were resistant and 7 were susceptible to TMP-SMX. Clinical response (day 5) showed cure, improvement, and failure in 89%, 8%, and 3%, respectively, of the cefixime group, and in 25%, 44%, and 31%, respectively, of the TMP-SMX-resistant group (p<0.001). Bacteriologic cure (day 3) occurred in 78% and 23% of the cefixime and TMP-SMX-resistant groups, respectively (p<0.001). Clinical or bacteriologic relapse (day 12) was infrequent in both groups. The response to treatment of the cefixime and the TMP-SMX-susceptible groups was similar. No significant side effects were noted. We conclude that cefixime is superior to TMP-SMX in the treatment of suspected shigellosis in areas with a high rate of resistance to TMP-SMX.
UR - http://www.scopus.com/inward/record.url?scp=0027421061&partnerID=8YFLogxK
U2 - 10.1016/S0022-3476(05)80867-4
DO - 10.1016/S0022-3476(05)80867-4
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AN - SCOPUS:0027421061
SN - 0022-3476
VL - 123
SP - 817
EP - 821
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 5
ER -