Antibiotic Resistance in Children with Bloody Diarrhea
AbstractShigellosis is an important public health problem, especially in developing countries. Antibiotic treatment of bacterial dysentery, aimed at resolving diarrhea or reducing its duration is especially indicated whenever malnutrition is present. First-line drugs include ampicillin and trimethoprim sulfamethoxazole(TMP-SMX); however multidrug-resistance has occurred and careful antibiotic selection must be considered in prescribing .When epidemiologic data indicate a rise in resistancy, fluoroquinolones may be used in adults and oral third-generation cephalosporins and nalidixic acid in children. All children (n=2400) with acute diarrhea who were admitted to the Pediatric department of Dr.sheykh Hospital Mashhad, Iran from March 2004 to March 2005 were selected and their stool culture were obtained, then positive cultures (312 cases,13% ) were evaluated by antibiogram. This study showed that in heavily populated areas of IRAN like Mashhad, 97% shigella strain isolated from children with bloody diarrhea were sensitive to nalidixic acid, ciprofloxacin and cefixime and rarely susceptible to ampicillin and cotrimoxazole. There is increasing resistance of Shigella to most of the antibiotics in use, and for this reason, careful selection of antibiotics must use considered in each area. Development and use of new drugs are expensive and have severe limitations in the third world. Simple prophylactic alternatives are therefore, required, such as awareness of hygienic child care practices and early promotion of breast feeding. For treatment of shigellosis in infants Ceftriaxon, and in children Nalidixic Acid is recommended.
Sack RB, Rahman M, Yunus M, Khan EH. Antimicrobial resistance in organisms causing diarrheal disease. Clin Infect Dis 1997; 24 Suppl 1: S102-5.
Moolasart P, Eampokalap B, Supaswadikul S. Comparison of the efficacy of tetracycline and norfloxacin in the treatment of acute severe watery diarrhea. Southeast Asian J Trop Med Public Health 1998; 29(1): 108-11.
Thornton SA, Wignall SF, Kilpatrick ME, Bourgeois AL, Gardiner C, Batchelor RA, et al. Norfloxacin compared to trimethoprim/sulfamethoxazole for the treatment of travelers' diarrhea among U.S. military personnel deployed to South America and West Africa. Mil Med 1992; 157(2): 55-8.
Bennish ML. Potentially lethal complications of shigellosis. Rev Infect Dis 1991; 13 Suppl 4: S319-24.
Iwalokun BA, Gbenle GO, Smith SI, Ogunledun A, Akinsinde KA, Omonigbehin EA. Epidemiology of shigellosis in Lagos, Nigeria: trends in antimicrobial resistance. JHealth Popul Nutr 2001; 19(3): 183-90.
Al-Moyed KA, Harmal NS, Al-Harasy AH, Al-Shamahy HA. Increasing single and multi-antibiotic resistance inShigella species isolated from shigellosis patients in Sana'a, Yemen. Saudi Med J 2006; 27(8): 1157-60.
Peirano G, Souza FS, Rodrigues DP; Shigella Study Group. Frequency of serovars and antimicrobial resistance in Shigella spp. from Brazil. Mem Inst Oswaldo Cruz 2006; 101(3): 245-50.
Alici O, Açikgöz ZC, Gamberzade S, Göcer S, Karahocagil MK. Antibiotic resistance rates of Shigella species isolated from stool cultures in the years 1999-2003. Mikrobiyol Bul 2006; 40(1-2): 9-14.
Sabir N, Zafar A. Cephalosporin resistant Shigella flexneri from a clinical isolate: a rare finding. J Pak Med Assoc 2005; 55(12): 560-1.
Wang XY, Du L, Von Seidlein L, Xu ZY, Zhang YL, Hao ZY, et al. Occurrence of shigellosis in the young and elderly in rural China: results of a 12-month population-based surveillance study. Am J Trop Med Hyg 2005; 73(2): 416-22.
Jain SK, Gupta A, Glanz B, Dick J, Siberry GK. Antimicrobial- resistant Shigella sonnei: limited antimicrobial treatment options for children and challenges of interpreting in vitro azithromycin susceptibility. Pediatr Infect Dis J 2005; 24(6): 494-7.
Zafar A, Sabir N, Bhutta ZA. Frequency of isolation of shigella serogroups/serotypes and their antimicrobial susceptibility pattern in children from slum areas in Karachi. J Pak Med Assoc 2005; 55(5): 184-8.
Ranjbar R. Soltani M, Pourshafie M. Epidemiology of Shigellosis with special reference to hospital distribution of Shigella strains in Tehran. Iranian J Clinical Infection Dis 2008; 3(1): 35-8.