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Meta-Analysis
. 2010 Aug 4;2010(8):CD006784.
doi: 10.1002/14651858.CD006784.pub4.

Antibiotic therapy for Shigella dysentery

Prince Rh Christopher  1 , Kirubah V David, Sushil M John, Venkatesan Sankarapandian
Affiliations
Meta-Analysis

Antibiotic therapy for Shigella dysentery

Prince Rh Christopher et al. Cochrane Database Syst Rev. .

Abstract

Background: Shigella dysentery is a relatively common illness and occasionally causes death, worldwide. Mild symptoms are self-limiting but in more severe cases, antibiotics are recommended for cure and preventing relapse. The antibiotics recommended are diverse, have regional differences in sensitivity, and have side effects.

Objectives: To evaluate the efficacy and safety of antibiotics for treating Shigella dysentery.

Search strategy: In June 2009 we identified all relevant trials from the following databases: Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, issue 4), MEDLINE, EMBASE, LILACS and the metaRegister of Controlled Trials (mRCT). We also checked conference proceedings for relevant abstracts, and contacted researchers, organizations, and pharmaceutical companies.

Selection criteria: Randomized controlled trials of antibiotics for Shigella dysentery.

Data collection and analysis: Four authors, working in pairs, independently assessed trial eligibility, methodological quality, and extracted data. We calculated risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data, and used the random-effects model for significant heterogeneity. We explored possible sources of heterogeneity, when present, in subgroup analyses of participant age and percentage of participants with confirmed Shigella infection.

Main results: Sixteen trials (1748 participants), spanning four decades and with differing sensitivity to Shigella isolates, met the inclusion criteria. Seven were judged to be at risk of bias due to inadequate allocation concealment or blinding, and 12 due to incomplete reporting of outcome data. Limited data from one three-armed trial of people with moderately severe illness suggest that antibiotics reduce the episodes of diarrhoea at follow-up (furazolidone versus no drug RR 0.21, 95% CI 0.09 to 0.48, 73 participants; cotrimoxazole versus no drug RR 0.30, 95% CI 0.15 to 0.59, 76 participants).There was insufficient evidence to consider any class of antibiotic superior in efficacy in treating Shigella dysentery, but heterogeneity for some comparisons limits confidence in the results. All the antibiotics studied were safe. There was inadequate evidence regarding the role of antibiotics in preventing relapses.

Authors' conclusions: Antibiotics reduce the duration of Shigella dysentery.Regularly updated local or regional antibiotic sensitivity patterns to different species and strains of Shigella are required to guide empiric therapy. More trials adhering to standard guidelines are required to evaluate the role of antibiotics in the treatment of severe forms of Shigella dysentery and in groups who are at high risk of complications.

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Conflict of interest statement

None known.

Figures

1
1
Methodological quality summary: review authors' judgments about each methodological quality item for each included study.
2
2
Methodological quality graph: review authors' judgments about each methodological quality item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Antibiotic versus no drug or placebo, Outcome 1 Diarrhoea on follow up.
1.2
1.2. Analysis
Comparison 1 Antibiotic versus no drug or placebo, Outcome 2 Time to cessation of fever (in days).
1.3
1.3. Analysis
Comparison 1 Antibiotic versus no drug or placebo, Outcome 3 Time to cessation of diarrhoea (in days).
1.4
1.4. Analysis
Comparison 1 Antibiotic versus no drug or placebo, Outcome 4 Time to cessation of blood in stools (in days).
1.5
1.5. Analysis
Comparison 1 Antibiotic versus no drug or placebo, Outcome 5 Other adverse events.
2.1
2.1. Analysis
Comparison 2 Fluoroquinolones versus beta‐lactams, Outcome 1 Diarrhoea on follow up.
2.2
2.2. Analysis
Comparison 2 Fluoroquinolones versus beta‐lactams, Outcome 2 Fever at follow up.
2.3
2.3. Analysis
Comparison 2 Fluoroquinolones versus beta‐lactams, Outcome 3 Relapse.
2.4
2.4. Analysis
Comparison 2 Fluoroquinolones versus beta‐lactams, Outcome 4 Bacteriological failure.
2.5
2.5. Analysis
Comparison 2 Fluoroquinolones versus beta‐lactams, Outcome 5 Development of severe complications.
2.6
2.6. Analysis
Comparison 2 Fluoroquinolones versus beta‐lactams, Outcome 6 Serious adverse events.
2.7
2.7. Analysis
Comparison 2 Fluoroquinolones versus beta‐lactams, Outcome 7 Adverse events leading to discontinuation of treatment.
2.8
2.8. Analysis
Comparison 2 Fluoroquinolones versus beta‐lactams, Outcome 8 Other adverse events.
3.1
3.1. Analysis
Comparison 3 Fluoroquinolones versus macrolides, Outcome 1 Diarrhoea on follow up.
3.2
3.2. Analysis
Comparison 3 Fluoroquinolones versus macrolides, Outcome 2 Fever at follow up.
3.3
3.3. Analysis
Comparison 3 Fluoroquinolones versus macrolides, Outcome 3 Time to cessation of blood in stools.
3.4
3.4. Analysis
Comparison 3 Fluoroquinolones versus macrolides, Outcome 4 Bacteriological failure.
3.5
3.5. Analysis
Comparison 3 Fluoroquinolones versus macrolides, Outcome 5 Other adverse events.
4.1
4.1. Analysis
Comparison 4 Cotrimoxazole versus beta‐lactams, Outcome 1 Diarrhoea on follow up.
4.2
4.2. Analysis
Comparison 4 Cotrimoxazole versus beta‐lactams, Outcome 2 Bacteriological failure.
4.3
4.3. Analysis
Comparison 4 Cotrimoxazole versus beta‐lactams, Outcome 3 Time to cessation of diarrhoea (hours).
4.4
4.4. Analysis
Comparison 4 Cotrimoxazole versus beta‐lactams, Outcome 4 Time to cessation of fever (hours).
4.5
4.5. Analysis
Comparison 4 Cotrimoxazole versus beta‐lactams, Outcome 5 Time to cessation of visible blood in stools.
4.6
4.6. Analysis
Comparison 4 Cotrimoxazole versus beta‐lactams, Outcome 6 Other adverse events.
5.1
5.1. Analysis
Comparison 5 Cotrimoxazole versus fluoroquinolones (norfloxacin), Outcome 1 Bacteriological failure.
5.2
5.2. Analysis
Comparison 5 Cotrimoxazole versus fluoroquinolones (norfloxacin), Outcome 2 Other adverse events.
6.1
6.1. Analysis
Comparison 6 Cotrimoxazole versus furazolidone, Outcome 1 Diarrhoea on follow up.
7.1
7.1. Analysis
Comparison 7 Oral gentamicin versus nalidixic acid, Outcome 1 Diarrhoea at follow up.
7.2
7.2. Analysis
Comparison 7 Oral gentamicin versus nalidixic acid, Outcome 2 Fever at follow up.
7.3
7.3. Analysis
Comparison 7 Oral gentamicin versus nalidixic acid, Outcome 3 Bacteriological relapse.
7.4
7.4. Analysis
Comparison 7 Oral gentamicin versus nalidixic acid, Outcome 4 Bacteriological failure.
8.1
8.1. Analysis
Comparison 8 Sulphonamides versus tetracycline, Outcome 1 Diarrhoea at follow up.
8.2
8.2. Analysis
Comparison 8 Sulphonamides versus tetracycline, Outcome 2 Bacteriological failure.
See this image and copyright information in PMC

Update of

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Martin 2000 {published data only}
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Matsuoka 1995 {published data only}
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Miles 1977 {published data only}
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Mol 1987 {published data only}
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Moolasart 1999 {published data only}
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Morisawa 1970 {published data only}
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Motohiro 1982 {published data only}
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Nelson 1975 {published data only}
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Nelson 1976 {published data only}
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Nikorowitsch 1978 {published data only}
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Oldfield 1987 {published data only}
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Orenstein 1981 {published data only}
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Ostrower 1979 {published data only}
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Petruccelli 1992 {published data only}
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Pichler 1986 {published data only}
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Pichler 1987 {published data only}
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Prado 1981 {published data only}
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Prado 1992 {published data only}
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Rabbani 1982 {published data only}
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Rakhmanova 1996 {published data only}
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Raqib 2008 {unpublished data only}
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Rogerie 1986 {published data only}
    1. Rogerie F, Ott D, Vandepitte J, Verbist L, Lemmens P, Habiyaremye I. Comparison of norfloxacin and nalidixic acid for treatment of dysentery caused by Shigella dysenteriae type 1 in adults. Antimicrobial Agents and Chemotherapy 1986;29(5):883‐6. - PMC - PubMed
Sagara 1993 {published data only}
    1. Sagara H, Tomizawa I, Takizawa Y, Yamaguchi T, Masuda G, Negishi I, et al. Clinical study of temafloxacin on infectious enteritis. Chemotherapy 1993;41(Suppl. 5):464‐78.
Sagara 1994 {published data only}
    1. Sagara H, Tomizawa I, Takizawa Y, Nitta Y, Tsunoda T, Yamaguchi T, et al. Basic and clinical studies of fleroxacin on infectious enteritis. Research Group of AM‐833 on infectious enteritis. Kansenshogaku Zasshi. Journal of the Japanese Association for Infectious Diseases 1994;68(11):1390‐408. - PubMed
Saito 1983 {published data only}
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Saito 1984 {published data only}
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Salam 1995 {published data only}
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Salam 1999 {published data only}
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Seto 1992 {published data only}
    1. Seto WH, Lau FL, Gotuzzo EH, Carillo C. Lomefloxacin versus trimethoprim/sulphamethoxazole in the treatment of adults with acute bacterial diarrhoea. International Journal of Antimicrobial Agents 1992;2(1):61‐6. - PubMed
Soares 1994 {published data only}
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Study Group 2002 {published data only}
    1. Zimbabwe, Bangladesh, South Africa (Zimbasa) Dysentery Study Group. Multicenter, randomised, double blind clinical trial of short course versus standard course oral ciprofloxacin for Shigella dysenteriae type 1 dysentery in children. Pediatric Infectious Disease Journal 2002;21(12):1136‐41. - PubMed
Tian 1986 {published data only}
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Varsano 1991 {published data only}
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Vinh 2000 {published data only}
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Wistrom 1992 {published data only}
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Xiouying 1986 {published data only}
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Yamamoto 1973 {published data only}
    1. Yamamoto T, Tsunoda O, Sugiyama S, Nakajima K, Akao M. Effects of lividomycin on bacillary dysentery and related disorders. Comparison with the effects of kanamycin by a double blind method. Kansenshogaku Zasshi. Journal of the Japanese Association for Infectious Diseases 1973;47(2):35‐43. - PubMed
Ye 1990 {published data only}
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Yin 1998 {published data only}
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Yunus 1982 {published data only}
    1. Yunus M, Rahman ASMM, Farooque AS, Glass RI. Clinical trial of ampicillin v. trimethoprim sulphamethoxazole in the treatment of Shigella dysentery. Journal of Tropical Medicine and Hygiene 1982;85(5):195‐9. - PubMed
Yuying 1995 {published data only}
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Zhang 1991 {published data only}
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References to studies awaiting assessment

Carbo 1981 {published data only}
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