Enrofloxacin treatment of long-tailed macaques with acute bacillary dysentery due to multiresistant Shigella flexneri IV.

Thirty-four cases of acute bacillary dysentery occurred within 90 days among macaques housed at the California Regional Primate Research Center. Cases were identified by depression, diarrhea with blood and leukocytic exudate, and/or leukocytosis with a left shift. Antimicrobial susceptibility testing of enteric isolates and plasmid profile analyses established an etiologic diagnosis of multiple antibiotic resistant Shigella flexneri IV infection. When standard therapies were invalidated by high frequencies of resistance among the isolates, therapy with enrofloxacin, a fluoroquinolone antimicrobial, was initiated to interrupt the epidemic. Serum concentrations of enrofloxacin and its primary metabolite ciprofloxacin were measured in selected cases. A serum concentration-time data analysis was performed to evaluate the oral enrofloxacin dose and dosing interval for nonfasted macaques. Once daily administration of 5 mg/kg enrofloxacin by gastric intubation produced 24-hour serum concentrations above the MICs for the Shigella isolates from this outbreak.