Chapter 8
Treatment for Shigella Infection
Anyone with a suspected Shigella infection should be tested for the presence of Shigella bacteria. Antibiotics can shorten the length of illness.
For many diarrheal illnesses, rehydration is the primary course of treatment; however, Shigella bacteria invade the mucosal lining of the colon, which may require an additional, more robust treatment. Although shigellosis is usually a self-limiting illness, antibiotics can shorten the course, and in severe cases, might be life-saving. Historically, the antibiotics commonly used for treatment of bacterial infections, like those caused by Shigella, were ampicillin, trimethoprim/sulfamethoxazole (TMP-SMZ, also known as Bactrim or Septra), or ceftriaxone (Rocephin). Ciprofloxacin is also commonly used to treat adults who are infected.
Unfortunately, Shigella bacteria have become resistant to one or more of these antibiotics. This means some antibiotics might not be effective for treatment, and that using (or overusing) antibiotics to treat shigellosis can sometimes make the bacteria more resistant. As noted in the 2012 National Antimicrobial Resistance Monitoring System (NARMS) final report, 89.2% of Shigella sonnei isolates were resistant to streptomycin, 41.8% were resistant to TMP-SMZ, 30% were resistant to sulfamethoxazole/sulfisoxazole, 27.5% were resistant to tetracycline, and 18.1% were resistant to ampicillin.
Recently, the World Health Organization (WHO) named Shigella as one of the eight priority pathogens in its Global Antimicrobial Resistance Surveillance System (GLASS) platform. The early implementation report from GLASS surveillance in 2020 revealed the following antibiotics as acceptable for use in shigellosis cases: fluoroquinolones (ciprofloxacin or levofloxacin), third-generation cephalosporins (ceftriaxone, cefotaxime, or ceftazidime), and macrolides (azithromycin).
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How is Shigellosis Diagnosed?
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Antimicrobial Resistance in Bacteria
