Antibiotics in the management of shigellosis in children: what role for the quinolones?

In the last 20 years, epidemic bacillary dysentery due to Shigella dysenteriae type 1 has become an important cause of serious morbidity and death in children less than 5 years of age in a number of developing countries; in many instances the infecting strains have been resistant to many or all of the usually recommended antibiotics. Moreover, an increasing proportion of Shigella strains of other serotypes isolated in all parts of the world are now resistant to the most commonly used antibiotics. The new fluoroquinolones have been shown to be active against Shigella in vitro and effective for the treatment of shigellosis in adults, but concern about the safety of quinolones has so far prevented the evaluation of these agents for the treatment of shigellosis in young children. Two observations, however, have led a Scientific Working Group of the World Health Organization to suggest that such studies would be appropriate for the following reasons: a one- or two-dose treatment is likely to be effective, and if so the amount of drug given would be far below the doses that have been determined to be toxic in animals; and nalidixic acid, which shares all the toxicity of the fluoroquinolones, is widely recommended--and in some areas routinely used--for the treatment of shigellosis in young children without reports of significant adverse effects. In the Group's view there is an urgent need to perform carefully conducted research to determine the safety and efficacy of fluoroquinolones for the treatment of shigellosis in children.