Document Detail


Treatment of shigellosis: IV. Cefixime is ineffective in shigellosis in adults.
MedLine Citation:
PMID:  7661494     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare the efficacy of cefixime with that of pivamdinocillin in the treatment of adults with acute dysentery caused by Shigella infection. DESIGN: Randomized, double-blind clinical trial. SETTING: A diarrhea treatment center in Dhaka, Bangladesh. PATIENTS: 30 men with dysentery lasting 72 hours or less. INTERVENTIONS: Patients were randomly assigned to receive either 400 mg of cefixime every 24 hours (n = 15) or 400 mg of pivamdinocillin every 6 hours (n = 15) for 5 days. All patients were hospitalized for 6 days. Patients in whom initial drug therapy failed received alternative antimicrobial therapy. MEASUREMENTS: Physical examinations were done and symptoms were recorded daily, and body temperatures were measured every 6 hours. Stools were counted and examined for consistency and for the presence of blood and mucus. Therapy failed if symptoms of dysentery persisted for more than 72 hours or if, on study day 5, a patient had six stools, one watery or bloody-mucoid stool, or an oral temperature higher than 37.8 degrees C. Bacteriologic failure of therapy occurred if Shigella could be isolated from a stool sample on or after study day 3. RESULTS: Therapy failed in seven (47%) patients given cefixime but in none of the patients given pivamdinocillin (P = 0.006). Patients given cefixime had longer duration of fever (median, 6 hours compared with 0 hours, P = 0.019), longer duration of the period with dysenteric stools (median, 4 days compared with 1 day, P = 0.001), and more stools during the 6 study days (median, 65 compared with 28, P = 0.002) than patients treated with pivamdinocillin. Bacteriologic failure of therapy occurred in 60% of patients (9 of 15) given cefixime and 13% of those (2 of 15) given pivamdinocillin (P = 0.009). CONCLUSION: Cefixime is ineffective in treating shigellosis in adults when used in the standard recommended dosage.
Authors:
M A Salam; C Seas; W A Khan; M L Bennish
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of internal medicine     Volume:  123     ISSN:  0003-4819     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  1995 Oct 
Date Detail:
Created Date:  1995-10-04     Completed Date:  1995-10-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  505-8     Citation Subset:  AIM; IM    
Affiliation:
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Amdinocillin Pivoxil / therapeutic use*
Anti-Bacterial Agents / therapeutic use*
Cefixime
Cefotaxime / analogs & derivatives*,  therapeutic use
Double-Blind Method
Dysentery, Bacillary / drug therapy*,  microbiology
Follow-Up Studies
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Shigella / classification
Treatment Failure
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 32886-97-8/Amdinocillin Pivoxil; 63527-52-6/Cefotaxime; 79350-37-1/Cefixime

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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