Anti Diarrhea/Diarrhoea Antimicrobials,Antisecretory Drugs:Shigellosis

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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ACUTE CHILDHOOD DIARRHEA: A REVIEW OF RECENT ADVANCES IN THE STANDARD MANAGEMENT

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Cholera

SEEMA ALAM RAJEEV KHANNA UZMA FIRDAUS
Pediatric Gastroenterology Section, Department of Pediatrics, JNMC, AMU, Aligarh

Corresponding Author :

Dr Seema Alam, Reader, Department of Pediatrics, JN Medical College, AMU, Aligarh, UP. Email seema_alam@hotmail.com

Antimicrobials and Antisecretory drugs

Bacillary dysentery or Shigellosis: Various studies on shigellosis done recently are available in the tabulated form (Table 8). High rates of resistance to various antibiotics are present, hence one of the fluoroquinolones (ciprofloxacin/norfloxacin/ofloxacin) should be the first line of treatment for Shigellosis. If there is no improvement (disappearance of blood), on the fluoroquinolone, within 48 hours then depending upon the general condition the patient should be shifted to a oral (Cefixime) or intravenous (ceftriaxone) cephalosporin. Drug dosage and schedule should be as mentioned in table 9. Based on its efficacy, safety and reduced cost, ciprofloxacin has been recommended by WHO as the first line Antibiotic for shigellosis 76 .

Table 8: Percentage resistance to antimicrobials in the shigella isolates (2001-2005) from the Indian subcontinent.

Ref	Place	Co (%)	NA (%)	Cx&/Nx (%)	Cef (%)	serogroup	Isolates (n)	MDR (%)
63	Siliguri	100	100	NT	NT	S. dysenteriae	30
64	Diamond Harbour	100	100	100	NT	S. dysenteriae	4	100
65	Kolkata	97	97	97	NT	S. dysenteriae	36	97
66	Kolkata	100	100	100	NT	S. dysenteriae	152	100
67	Kolkata	100	100	75	NT	S. dysenteriae	17	100
68	Kolkata	95	59	6	NT	S. flexneri	68	90
69	Aizawl	100	100	100	0	S. dysenteriae	169	100
70	Dhaka	98	98	0	NT	S. dysenteriae	122	98
71	Dhaka	55	9	0	NT	S. flexneri	193	40
72	Karachi	88	39	0	0	S. flexneri	193	40
73	Lahore	NT	6	0	0	S. dysenteriae	77	70
74	Chandigarh	58	63	12	14	S. flexneri	55	43
75	Vellore	NT	94	NT	NT	S. sonnei
		99*	97*	38.5*	0*			97**

Co=Cotrimoxazole, NA=Nalidixic acid, Cx&/Nx=Ciprofloxacin&/Norfloxacin, Cef=Cefixime/Ceftriaxone
NT=Not tested
MDR= Multidrug resistance
* Median percentage resistance to the antimicrobials
** Median percentage Multidrug resistance.

Table 9: Drugs dosage and schedules for the antibiotics against Shigellosis.

Drug	Dosage (mg/kg/day)	Divided dose	Duration (days)
Ciprofloxacin ( PO )	20	2	5
Norfloxacin ( PO )	20	2	5
Ofloxacin ( PO )	15	2	5
Ceftriaxone (IV)	100	2	5
Cefixime ( PO )	8	2	5

PO = Per oral, IV= intravenous

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