Ontology highlight
ABSTRACT: Background
The bacterial genus Shigella is the leading cause of dysentery. There have been significant increases in the proportion of Shigella isolated that demonstrate resistance to nalidixic acid. While nalidixic acid is no longer considered as a therapeutic agent for shigellosis, the fluoroquinolone ciprofloxacin is the current recommendation of the World Health Organization. Resistance to nalidixic acid is a marker of reduced susceptibility to older generation fluoroquinolones, such as ciprofloxacin. We aimed to assess the efficacy of gatifloxacin versus ciprofloxacin in the treatment of uncomplicated shigellosis in children.Methodology/principal findings
We conducted a randomized, open-label, controlled trial with two parallel arms at two hospitals in southern Vietnam. The study was designed as a superiority trial and children with dysentery meeting the inclusion criteria were invited to participate. Participants received either gatifloxacin (10 mg/kg/day) in a single daily dose for 3 days or ciprofloxacin (30 mg/kg/day) in two divided doses for 3 days. The primary outcome measure was treatment failure; secondary outcome measures were time to the cessation of individual symptoms. Four hundred and ninety four patients were randomized to receive either gatifloxacin (n=249) or ciprofloxacin (n=245), of which 107 had a positive Shigella stool culture. We could not demonstrate superiority of gatifloxacin and observed similar clinical failure rate in both groups (gatifloxacin; 12.0% and ciprofloxacin; 11.0%, p=0.72). The median (inter-quartile range) time from illness onset to cessation of all symptoms was 95 (66-126) hours for gatifloxacin recipients and 93 (68-120) hours for the ciprofloxacin recipients (Hazard Ratio [95%CI]=0.98 [0.82-1.17], p=0.83).Conclusions
We conclude that in Vietnam, where nalidixic acid resistant Shigellae are highly prevalent, ciprofloxacin and gatifloxacin are similarly effective for the treatment of acute shigellosis.
SUBMITTER: Vinh H
PROVIDER: S-EPMC3149021 | biostudies-literature | 2011 Aug
REPOSITORIES: biostudies-literature
Vinh Ha H Anh Vo Thi Cuc VT Anh Nguyen Duc ND Campbell James I JI Hoang Nguyen Van Minh NV Nga Tran Vu Thieu TV Nhu Nguyen Thi Khanh NT Minh Pham Van PV Thuy Cao Thu CT Duy Pham Thanh PT Phuong Le Thi le T Loan Ha Thi HT Chinh Mai Thu MT Thao Nguyen Thi Thu NT Tham Nguyen Thi Hong NT Mong Bui Li BL Bay Phan Van Be PV Day Jeremy N JN Dolecek Christiane C Lan Nguyen Phu Huong NP Diep To Song TS Farrar Jeremy J JJ Chau Nguyen Van Vinh NV Wolbers Marcel M Baker Stephen S
PLoS neglected tropical diseases 20110802 8
<h4>Background</h4>The bacterial genus Shigella is the leading cause of dysentery. There have been significant increases in the proportion of Shigella isolated that demonstrate resistance to nalidixic acid. While nalidixic acid is no longer considered as a therapeutic agent for shigellosis, the fluoroquinolone ciprofloxacin is the current recommendation of the World Health Organization. Resistance to nalidixic acid is a marker of reduced susceptibility to older generation fluoroquinolones, such ...[more]