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Ciprofloxacin, Ceftriaxone and Pivmecillinam on Dysentery in Children

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Reference
Traa BS, Walker CL, Munos M, Black RE. Antibiotics for the treatment of dysentery in children. Int J Epidemiol. 2010 Apr; 39 (Suppl 1): i70-4.

Background

  • Case fatality ratios as high at 6.1% have been reported during epidemics of Shigella dysenteriae type I. (1)
  • WHO recommends that all episodes of diarrhea with blood in the stool be treated with one of the following antibiotics: ciprofloxacin, pivmecillinam, azithromycin, ceftriaxone. (2)

Intervention

Treatment of individuals < 16 years of age with one of three antibiotics (Ciprofloxacin, Ceftriaxone and Pivmecillinam) for dysentery. 

  • 0.1% clinical failure rate (95% ci: -0.2% to 0.5%) – 12 data points from 8 studies

Treatment of individuals < 16 years of age with one of three antibiotics (Ciprofloxacin, Ceftriaxone and Pivmecillinam) for dysentery. 

  • 0% relative risk of bacteriological failure (-0.1 to 0.1%) – 6 datasets from 4 studies

Treatment of individuals < 16 years of age with one of three antibiotics (Ciprofloxacin, Ceftriaxone and Pivmecillinam) for dysentery. 

  • 0% relative risk of bacteriological relapse (-0.1% to 0.1%) – 7 datasets from five studies

Intervention Recommendation:  STRONG

  • Extrapolating clinical failure to mortality, meta-analysis indicates >99% of dysentery deaths can be prevented with ciprofloxacin, ceftriaxone and or pivmecillinam treatment.

References from Traa Paper Cited Here

  1. Huppertz HI.  An epidemic of bacillary dysentery in western Rwanda 1981-82.  Cent Afr J Med 1986; 32: 79-82.
  2. World Health Organization.  Department of Child and Adolescent Health and Development.  Guidelines for the Control of Shigellosis, Including Epidemics due to Shigella Dysenteriae Type I. Geneva, 2005.

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