Management
The classically taught complication of generalized seizure is not common, and its pathophysiology is not well understood - Brian C. Phillips MD,
HWN Suggests
Shaking Down Shigella
The majority of S. sonnei isolates are now resistant to trimethoprim/sulfamethoxazole and ampicillin. Current therapies for children include azithromycin as a first-line agent (12mg/kg up to 500 mg on the first day, and 6mg/kg up to 250mg on days 2 through 5), cefixime, parenteral ceftriaxone, or a fluoroquinolone (not approved for patients <18, though they have been used successfully). The first-line therapy for adults is a fluoroquinolone, typically ciprofloxacin.
Articles of Interest
A treatment dilemma: Extensively drug-resistant Shigella
Because of the lack of current available treatment options for XDR Shigella, we need to focus our attention on prevention... Shigella vaccine development has been a battle that has been ongoing for the last century. Thus far, it has been exceedingly difficult to balance an adequate immune response along with an acceptable side effect profile. Although there are several Shigella vaccines at various stages of clinical development, it is unlikely that one will be available in the near future.
CDC issues an alert...Super Shigella on the Rise
In late February 2023, the Centers for Disease Control and Prevention (CDC) issued a health advisory due to an increase in cases of extensively drug-resistant (XDR) Shigella species. XDR Shigella are strains that are resistant to azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole, and ampicillin. There are currently no CDC recommendations for treating XDR shigellosis. Alternate antibiotics are limited by US availability, lack of clinical data, as well as poor efficacy for infections in the gut lining.
Extensively drug-resistant Shigella infections are increasing. Here’s what you need to know
In 2015, there were no reports to the CDC of extensively drug-resistant shigellosis. But by 2022, 5% of all shigellosis cases were extensively drug-resistant. While this may not sound like a huge increase, with global travel connecting more people, public health officials are concerned about its potential to spread. Extensively drug-resistant shigellosis is not curbed by three different classes of common antibiotics — macrolide, quinolone and cephalosporins — and it does not respond to common antibiotic alternatives. Researchers are in the process of developing effective treatments. Antibiotics from the carbapenem class may be useful, according to Emerging Pathogens Institute Director J. Glenn Morris, Jr., M.D.
Increase in Resistant Shigella Infections: 5 Things to Know about Shigella XDR
Regular Shigellosis is not a big deal; XDR Shigellosis is extremely dangerous because it cannot be killed by antibiotics. Infected individuals typically recover from regular shigellosis with rest and fluids, with antibiotics only needed if there is fear of an outbreak or the patient has a weak immune system. XDR Shigella is resistant to all empiric and alternative antibiotics, including azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole (TMP-SMX), and ampicillin. The CDC currently has no recommendations for treatment.
Resources
StatPearls
In pediatrics, the first-line drug is azithromycin if antibiotic susceptibility is unknown. In a randomized trial, Azithromycin was found to be clinically and bacteriological successful in 82% and 94% of patients treated respectively.[ Cefixime and ceftibuten can be used as first-line to treat shigellosis in South Asia due to widespread resistance to commonly used antibiotics. The alternative regimen includes pivmecillinam, an extended-spectrum penicillin is effective in decreasing diarrhea duration and eradication of shigella organisms in the stool.
