The considerable epidemic potential of Shigelloses in extreme situations determines their socio-medical significance and therapeutic challenge. In the First Infectious Clinic, Department of Infectious Diseases and Epidemiology, Medical University of Varna, 30 patients aged between 18 and 51 years were administered ciprofloxacine at a dose of 500 mg twice daily for one day only. Their mean hospital stay was 7,48 ± 1,27 days long. The control group consisted of 24 age-matched patients treated with other chemotherapeutic drugs for 3-5 days which mean hospitalization was 8,04 ± 2,99 days long. In 27 ciprofloxacine-treated patients the clinical healing occurred on the third hospital day. The febrility disappeared and the stools normalized. The pathological  admixtures of mucus and blood disappeared until the third day. The authors conclude that the one-day treatment of shigellosis with ciprofloxacine is safe and effective. The short duration of the therapy reduces the isolation period. No side effects are observed at all

Nenova, M.

Nikolova, D.

English

Varna Medical University Press: Journals

Scripta Scientifica Medica, vol. 32 (2000), pp 59-62 Copyright © Medical University, Varna O N E - D A Y T R E A T M E N T O F S H I G E L L O S I S W I T H C I P R O F L O X A C I N E M. Nenova, D. Nikolova Department of Infectious Diseases, Medical University of Varna A B S T R A C T The considerable epidemic potential of Shigelloses in extreme situations determines their socio-medical signif­icance and therapeutic challenge. In the First Infectious Clinic, Department of Infectious Diseases and Epide­miology, Medical University of Varna, 30 patients aged between 18 and 51 years were administered ciprofloxacine at a dose of 500 mg twice daily for one day only. Their mean hospital stay was 7,48 ± 1,27 days long. The control group consisted of 24 age-matched patients treated with other chemotherapeutic drugs for 3-5 days which mean hospitalization was 8,04 ± 2,99 days long. In 27 ciprofloxacine-treated patients the clini­cal healing occurred on the third hospital day. The febrility disappeared and the stools normalized. The pathological admixtures of mucus and blood disappeared until the third day. The authors conclude that the one-day treatment of shigellosis with ciprofloxacine is safe and effective. The short duration of the therapy re­duces the isolation period. No side effects are observed at all. Key words: Shigellosis, ciprofloxacine, one-day treatment, Shigella sensitivity, duration of hospitalization I N T R O D U C T I O N During the recent 3 years, the incidence rate of Shigella in­fections in Bulgaria varies between 30 and 40 %000 mani­fested by alternating decrease and increase (2). Obviously, these values are typical of this country taking into consider­ation the present sanitary-hygienic environment and health education of the population. The mortality and lethality rates remain relatively unchanged in 1997 and 1998, too, i. е., of 0,11 %000 and 0,34%000, respectively (1,2). The epi­demic process is characterized by sporadic cases and/or ep­idemic outbreaks that prevail in children's homes, mater­nity homes, social care homes, psychiatric clinics, etc. The morbidity rate of Shigellosis increases in some coun­tries like Chile but decreases in other ones like Poland (11,14). The considerable epidemic potential of Shigelloses in extreme situations determines their socio-medical signif­icance and therapeutic challenge. The management strategy is complicated by the continuously enlarging multi-drug re­sistance of a series of Shigella strains towards gentamycin, chloramphenicol, TMP-SMX, ampicillin, cephalosporins, etc. (4-9,11,14). On the contrary, a preserved susceptibility towards quinolones has recently been reported (7-9,11). The epidemic course of bacterial dysentery in the town and region of Varna, Bulgaria, in summer necessitates a timely looking for new therapeutic schedules for this disease. Address for correspondence: M. Nenova, Dept. of Infections Diseases, Medical University ofVania, 55 Marin Drinov St, BG-9002 Varna, BULGARIA E-mail: infect@asclep.muvar.acad.bg Since 1973, an important task of the Department of Infec­tious Diseases, Medical University of Varna, consists in the creation of a shortened therapeutic course of Shigella infec­tions. A lot of combinations of chemotherapeutic drags ap­plied at an optimal dosage for 24 or 48 hours have already been approved (10) (Table 1). Table I . Therapeutic combinations for Shigellosis No Drug combinations Daily dosage 1. Chloramphenicol Nalidix 4x0,5 3x 1,0 2. Kanamycin per os Nalidix 4x 1,0 4x 1,0 3. Chloramphenicol Kanamycin per os 4x0,5 4x 1,0 4. Ampicillin Kanamycin per os 4x0.5 4x1,0 5. Tetracycline (Tetraolean) 4x0,5 6. TMP-SMZ 3 x 0,48 7. Ampicillin Streptomycin per os 4x0,5 4x 1,0 As there are reports in the literature available about the us­age of ciprofloxacine in the management of Shigella infec-59 M. Nenova, D. Nikolova tions (3) we decided to prove the effectiveness of a short­ened schedule in our patients, too. The aim of the present study is to follow-up the opportuni­ties for one-day treatment of Shigellosis with ciprofloxacine based on literature data available (2,3,12,13). M A T E R I A L AND M E T H O D S Out of a total of 196 bacterial dysentery cases in the town and region of Varna, Bulgaria, 57 patients aged over 14 years and hospitalized in the First Infectious Clinic, Depart­ment of Infectious Diseases and Epidemiology, in 1998 were followed-up. Thirty patients aged between 18 and 51 years (at a mean age of 20,79 ± years) were administered ciprofloxacine at a dose of 500 mg twice daily for one day only. With 24 soldiers in a military outfit (80 % of the cases), S. sonnei was isolated, in 3 patients (10 % of the cases), S.flexneri 2a was found; in two patients (6,67 % of the cases) S.flexneri la was established, but in one patient (3,33 % of the cases) both S. sonnei and S.flexneri lb were proved (Fig. 1). The distribution of the Shigella strains in the control group is demonstrated on Fig. 2. 1 24 Ы S. flexneri la H S. sonnei Ш S. flexneri 2a • S. sonnei + S.flexneri lb ig. 1. Relative share of Shigella species isolated in ttients treated with ciprofloxacine ean hospital stay was 7,48 ± 1,27 days long. The control oup consisted of 24 age-matched patients treated with ner chemotherapeutic drugs for 3-5 days. Their mean spitalization was 8,04 ± 2,99 days long. The diagnosis of igella infection was made using routine clinical and idemiologic data and confirmed by microbiological ex-lination of the faecal cultures. inical healing was assessed according to the absent mu-os-bloody diarrhoea while microbiological sanation was proved according to the absent Shigellae during two control examinations of the faeces for bacterial flora in two consec­utive days 24 hours after ciprofloxacine treatment cessa­tion. 18 ?A S.flexneri la US. sonnei H S. flexneri 2a Ш S. flexneri lb Fig. 2. Relative share of Shigella species isolated in control patients R E S U L T S AND D I S C U S S I O N Some of our data are illustrated on Tables 2 and 3. Table 2 shows the characteristics of Shigellosis in the pa­tients with ciprofloxacine therapy and in the control pa­tients. The sensitivity of the different Shigella strains towards some chemotherapeutic means is demonstrated on Table 3. It should be mentioned that the epidemic outbreak in the military outfit was due to the poor sanitary-hygienic condi­tions and causing a contact mechanism of infection. Pa­tients' hospitalization was performed on the second and third day after the onset of complaints. One soldier was an infection carrier and did not demonstrate any clinical symp­toms of the disease. The clinical course was typical of the disease manifested by a moderately severe colitis and febrile intoxication syn­drome with the rest patients. There was a certain dehydratation was noted in 17 patients necessitating a supplementation of a peroral and parenteral rehydratation along with the etiologic therapy. The isolation of S. Sonnei coincided with the increasing incidence rate of this strain in other epidemic outbreaks in the country. In 1998, S.flexneri was isolated in 63 % but S. sonnei in the rest 37 % of the cases (2). Ciprofloxacin therapy started after taking the samples for microbiological testing already at the day of hospitalization. One-day treatment of shigellosis with ciprofloxacine Table 2. Characteristics of Shigellosis No Parameters Ciprofloxacine group (n=30) Control group (n=24) 1. Prehospital duration of disease (days) 1чЗ (1,75±1,47) 1чЗ (2,10±1,20) 2. Stool frequency before treatment / 24 h (3-4 4 15-20) 29 (96,67 % ) 24(100%) 3. Vomiting 0 4(16,67%) 4. Anorexia 29 (96,67 % ) 24(100%) 5. Abdominal pain 27(90%) 24(100%) 6. Fever (37,3 ОС ч 40 ОС) 17(56,67%) 16(80%) 7. Abdominal tenderness 13(43,33%) 13(54,17%) 8. Colitis sigmoidea spastica 15(50%) 13(54,17%) 9. Dehydratation 20(66,67%) 16(66,67%) 10. Bloody mucoid diarrhea 25 (83,33 % ) 20 (83,33 % ) 11. Asymptomatic patients 1 (3,33 % ) 0 12. Leukocytosis: > 10 G/l 4(13,33%) 10(41,67%) <4G/\ 3(10%) 1 (4,17%) Table 3. Sensitivity and resistance of two Shigella strains to antibacterial agents S. sonnei S. flexneri 2a R(%) S(%) I ( % ) R ( % ) S(%) Ampicillin 100 83 17 Piperacillin 73.33 23,33 3,34 88 12 Chloramphenicol 26,67 40 33,33 83 17 Cephalosporins 23,33 53,33 23,34 33 45 22 Gentamycin 50 33,33 16,67 4 % Amikalin 40 50 10 12 88 TMP-SMZ 36,66 50 13,34 40 50 10 Nalidixic acid 100 100 Ciprofloxacine 100 100 In 27 patients (90 % of the cases), the clinical healing oc­curred on the third hospital day. The febrility disappeared and the stools normalized. The pathological admixtures of mucus and blood disappeared until the third day. One case required prolongation of the therapy with another drug, i.e., with nelidix. The bacteriological sanation occurred during a period of 5,48 ± 1,57 days in 96,67 per cent of the cases but -after 7,80 ± 2,53 days (t = 4,40; p < 0,001) in the control group. No side effects after ciprofloxacine application were ob­served at all. C O N C L U S I O N S 1. One-day treatment with ciprofloxacine is safe and exerts a very good clinical and bacteriological effect. 2. Short duration of the therapy reduces the isolation period and seems, therefore, economically more effective. 3. There are neither side reactions, nor unwanted effects after the administration of ciprofloxacine at all. 61 M. Nenova, D. Nikolova R E F E R E N C E S 1. Димов, Ц., В. Зозиков, В. Желязкова, Б. Койнова, П. Манолов, М. Ненова. В: IV. Нац. конгр. по заразни и паразитни болести. Сб. доклади. Варна, 1976, 27-28. 2. Информационен бюлетин на НЦЗПБ. София, 1998,3-9. 3. Bennish, М. L . , М. A . Salam, R. Haider, М. Barza. J. Infect. Dis., 162, 1990, 711-716. 4. Cheasty, Т., J . A . Skinner, B . Rowe, E . J . Threlfal l . Microb. Drug Resist., 4, 1998, 57-60. 5. Frieden, T . R. , R. J . Mangi. JAMA, 264, 1990, 1438-1440. 6. Gendrel, D., J . L . Moreno, M. Nduwimana, C. Baribwira, J . Raymond. Clin. Infect. Dis., 24, 1997, 83. 7. Hoge, C. W., J . M. Gambel, A . Srijan, C . Pitarangsi, P. Echeverria. Clin. Infect. Dis., 26, 1998, 341-345. 8. Hossain, M. A . , M. Rahman, O. S. Ahmed, M. A . Malek, R. B . Sack, M. J . Albert. J. Antimicrob. Chemother., 42, 1998, 99-102. 9. Jamal, W. Y . , V. O. Rotimi, T . D. Chugh, T . Pal. J. Chemother., 10, 1998, 285-290. 10. Nikolova, D. , M. Nenova, A . Knyazheva, R. Vasi leva, H. Dimitrova. Scr. Sci. Med.,29, 1997, Suppl. 4, 135-138.. 11. Prado, V . , P. Pidal, C . Arellano, R. Lagos, O. San Martin. Rev. Med. Chile, 126, 1998, 1464-1471. 12. Salam, M. A . , M. L . Bennish. J. Pediatr., 113, 1988, 901. 13. Salam, M. A . , U . Dhar, W. A . Khan, M. L . Bennish. Lancet, 352, 1998, 522-527. 14. Stypulkowska-Misiurewicz, H . , E . Gonera. Przegl. Epidemiol., 3, 1999, 93-101. 

ONE-DAY TREATMENT OF SHIGELLOSIS WITH CIPROFLOXACINE

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ONE-DAY TREATMENT OF SHIGELLOSIS WITH CIPROFLOXACINE

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