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Comparative efficacy of cefixime and ampicillin-sulbactam in shigellosis in children
M Helvaci1, D Bektaşlar, B Ozkaya
1Department of Pediatrics, SSK Tepecik Teaching Hospital, Izmir, Turkey.
Abstract:
Shigellosis is still an important health problem in developing and underdeveloped countries as it is resistance to commonly used antibiotics including ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol and tetracycline. Between May 1996 and October 1996, in a prospective randomized double-blind trial, cefixime was compared with ampicillin-sulbactam, both given orally for a period of 5 days, for the treatment of 80 children with acute bloody diarrhea. Forty patients were treated with a single-dose (8 mg/kg per day) of cefixime and the other 40 patients were given three doses of 100 mg/kg per day of ampicillin-sulbactam. After identification of Shigella organisms in stool specimens, nine patients in the cefixime receiving group and six patients in the ampicillin-sulbactam receiving group were excluded from the study. Differences in average age, sex and weight between the cefixime and ampicillin-sulbactam group were statistically meaningless (P > 0.05). Fever and bloody diarrhea were universal features. The efficacy of cefixime was found to be better than ampicillin-sulbactam. Patients given cefixime had a shorter duration of fever (P < 0.01), shorter duration to disappearance of blood in the stool (P < 0.01), reduced time with diarrhea (P < 0.01) and reduced hospitalization time during the 5 study days (P < 0.01) than patients given ampicillin-sulbactam. No adverse effects were observed in the two study groups. This controlled trial showed good efficacy with cefixime compared to ampicillin-sulbactam in the treatment of shigellosis. Single-dose daily oral therapy with cefixime also showed good tolerability. Cefixime should be considered as an alternative drug of choice for shigellosis in children.
Insights
Cefixime offers a superior treatment for childhood shigellosis compared to ampicillin-sulbactam, reducing fever, bloody stools, and hospitalization. This oral therapy is well-tolerated and effective against antibiotic-resistant bacteria.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Shigellosis remains a significant public health issue, particularly in developing nations.
- Antibiotic resistance to common treatments like ampicillin and tetracycline complicates shigellosis management.
- Acute bloody diarrhea in children necessitates effective and safe therapeutic options.
Purpose of the Study:
- To compare the efficacy and tolerability of cefixime versus ampicillin-sulbactam for treating shigellosis in children.
- To evaluate clinical outcomes including duration of fever, bloody stools, and hospitalization.
- To assess the safety profile of cefixime in pediatric patients with shigellosis.
Main Methods:
- A prospective, randomized, double-blind trial involving 80 children with acute bloody diarrhea.
- Patients received either a single daily oral dose of cefixime (8 mg/kg) or three daily doses of ampicillin-sulbactam (100 mg/kg) for 5 days.
- Clinical data on fever, stool characteristics, and hospitalization duration were collected and analyzed.
Main Results:
- Cefixime demonstrated significantly better efficacy than ampicillin-sulbactam (P < 0.01).
- Patients treated with cefixime experienced shorter durations of fever, bloody stools, and overall illness.
- Reduced hospitalization time was observed in the cefixime group, with no reported adverse effects.
Conclusions:
- Cefixime is a highly effective and well-tolerated oral treatment for childhood shigellosis.
- Single-daily dosing of cefixime presents a viable alternative for managing shigellosis, especially in the context of antibiotic resistance.
- Cefixime should be considered a preferred therapeutic option for pediatric shigellosis.