UMEM Educational Pearls

Category: International EM

Title: Reduced Shigella Susceptibility to Ciprofloxacin

Keywords: CDC, Shigella, antibiotic, health advisory (PubMed Search)

Posted: 4/19/2017 by Jon Mark Hirshon, MD, MPH (Updated: 6/28/2017)
Click here to contact Jon Mark Hirshon, MD, MPH

Takeaways

The Centers for Disease Control and Prevention (CDC) just released an official health advisory through the Health Alert Network entitled: “CDC Recommendations for Diagnosing and Managing Shigella Strains with Possible Reduced Susceptibility to Ciprofloxacin”

 

Concerning treatment, one key point is:

Do not routinely prescribe antibiotic therapy for Shigella infection. Instead, reserve antibiotic therapy for patients for whom it is clinically indicated or when public health officials advise treatment in an outbreak setting.

o   Shigellosis is generally a self-limited infection lasting 5-7 days.

o   Unnecessary treatment with antibiotics promotes resistance.

o   Treatment can shorten the duration of some illnesses, though typically only by 1-2 days

In-Depth

This Health Advisory describes the identification of emerging Shigella strains with elevated minimum inhibitory concentration values for ciprofloxacin and outlines new recommendations for clinical diagnosis, management, and reporting, as well as new recommendations for laboratories and public health officials. There are more details available on the website: https://emergency.cdc.gov/han/han00401.asp

 

RECOMMENDATIONS FOR CLINICIANS

Diagnosis

·       Order stool culture for patients suspected of having a Shigella infection to obtain isolates for antimicrobial susceptibility testing.

·       Order antimicrobial susceptibility testing when ordering stool culture for Shigella.

Management

·       Do not routinely prescribe antibiotic therapy for Shigella infection. Instead, reserve antibiotic therapy for patients for whom it is clinically indicated or when public health officials advise treatment in an outbreak setting.

·       When antibiotic treatment is indicated, tailor antibiotic choice to antimicrobial susceptibility results as soon as possible with special attention given to the MIC for fluoroquinolone antibiotics.

·       Obtain follow-up stool cultures in shigellosis patients who have continued or worsening symptoms despite antibiotic therapy.

·       Consult your local or state health department for guidance on when patients may return to childcare, school, or work.

·       Counsel patients with active diarrhea on how they can prevent spreading the infection to others, regardless of whether antibiotic treatment is prescribed.

References

https://emergency.cdc.gov/han/han00401.asp