0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Treatment of Shigellosis: V. Comparison of Azithromycin and Ciprofloxacin: A Double-Blind, Randomized, Controlled Trial

Wasif Ali Khan, MB, BS; Carlos Seas, MD; Ujjwal Dhar, MB, BS; Mohammed Abdus Salam, MB, BS; and Michael L. Bennish, MD
[+] Article, Author, and Disclosure Information

From the International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Universidad Peruana Cayetano Heredia, Lima, Peru; and New England Medical Center, Boston, Massachusetts. Acknowledgments: The authors thank M. Begum for laboratory support; H. Kabir for assistance with data entry; and J.A. Herrington, J.A. Federici, and J.M. Remy for assaying drug concentrations. Grant Support: By the International Centre for Diarrhoeal Disease Research, Bangladesh, and by Pfizer, Inc. Dr. Seas was supported by a fellowship from the Swedish Agency for Research Cooperation with Developing Countries. Requests for Reprints: Michael Bennish, MD, New England Medical Center, 750 Washington Street, Box 091, Boston, MA 02111. Current Author Addresses: Drs. Khan, Dhar, and Salam: International Centre for Diarrhoeal Disease Research, Bangladesh, GPO Box 128, Dhaka 1000, Bangladesh.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;126(9):697-703. doi:10.7326/0003-4819-126-9-199705010-00004
Text Size: A A A

Background: Treatment of shigellosis is currently limited by the high prevalence of multidrug-resistant strains of Shigella.

Objective: To determine the efficacy of azithromycin in the treatment of shigellosis.

Design: Randomized, double-blind clinical trial.

Setting: Diarrhea treatment center in Dhaka, Bangladesh.

Patients: 70 men with shigellosis that had lasted 72 hours or less.

Interventions: Patients stayed in the hospital for 6 days. Thirty-four patients were randomly assigned to receive 500 mg of azithromycin on study day 1, followed by 250 mg once daily for 4 days; 36 patients were assigned to receive 500 mg of ciprofloxacin every 12 hours for 5 days.

Measurements: Clinical treatment failure was considered to have occurred if frank dysentery persisted for 72 hours after therapy began or if on study day 5 a patient had more than six stools, had any bloody-mucoid stools, had more than one watery stool, or had an oral body temperature exceeding 37.8 °C. Bacteriologic treatment failure was considered to have occurred if Shigella strains could be isolated from a stool sample after study day 2. Therapy was considered either clinically or bacteriologically successful in patients who completed therapy and did not meet criteria for failure.

Results: Therapy was clinically successful in 28 (82%) patients who received azithromycin and 32 (89%) patients who received ciprofloxacin (difference, −7%[95% CI, −23% to 10%]). Therapy was bacteriologically successful in 32 (94%) patients receiving azithromycin and 36 (100%) patients receiving ciprofloxacin (difference, −6%[CI, −14% to 2%]). Peak serum concentrations of azithromycin were equal to the minimum inhibitory concentration (MIC) of the infecting Shigella strains, whereas serum concentrations of ciprofloxacin were 28 times the MIC. Stool concentrations of both drugs were more than 200 times the MIC.

Conclusion: Azithromycin is effective in the treatment of moderate to severe shigellosis caused by multidrug-resistant Shigella strains.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Journal Club
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)