[Ciprofloxacin in the treatment of dysentery caused by type 1 Shigella dysenteriae during an epidemic in Rwandan refugees in Goma in 1994].

There was an outbreak of dysentery caused by type I Shigella dysenteriae among Rwandan refugees at Goma, in what was then Zaire, in 1994. The causal organism was resistant to all antibiotics available from the public health authorities. The only effective antimicrobial agent available was ciprofloxacin. It was given to 326 inpatients at the Médecins Sans Frontières (MSF) Center, mostly children under the age of 5, pregnant women and immunocompromised patients. A standard dose schedule was used: 1 g ciprofloxacin per day in two doses for 5 days for adults, 250 mg for children weighing less than 20 kg and 500 mg for children weighing less than 50 kg. The treatment was effective in 285 patients (85.6%) according to clinical criteria. Treatment was unsuccessful in 6 patients and 14 decided to stop taking the medication although it was having a positive effect. No side effects clearly caused by the treatment have been reported. This is consistent with previous reports showing that ciprofloxacin is clinically effective against epidemic dysentery caused by multi-drug resistant Shigella dysenteriae type I. However, fluoroquinolones are expensive and difficult to obtain and their use would require improvements in logistics and compliance.