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Comparative efficacy of cefixime and ampicillin‐sulbactam in shigellosis in children

Abstract Shigellosis is still an important health problem in developing and underdeveloped countries as it is resistance to commonly used antibiotics including ampicillin, trimethoprim‐sulfamethoxazole, chloramphenicol and tetracycline. Between May 1996 and October 1996, in a prospective randomized double‐blind trial, cefixime was compared with ampicillin‐sulbactam, both given orally for a period of 5 days, for the treatment of 80 children with acute bloody diarrhea. Forty patients were treated with a single‐dose (8 mg/kg per day) of cefixime and the other 40 patients were given three doses of 100 mg/kg per day of ampicillin‐sulbactam. After identification of Shigella organisms in stool specimens, nine patients in the cefixime receiving group and six patients in the ampicillin‐sulbactam receiving group were excluded from the study. Differences in average age, sex and weight between the cefixime and ampicillin‐sulbactam group were statistically meaningless (P > 0.05). Fever and bloody diarrhea were universal features. The efficacy of cefixime was found to be better than ampicillin‐sulbactam. Patients given cefixime had a shorter duration of fever (P<0.01), shorter duration to disappearance of blood in the stool (P<0.01), reduced time with diarrhea (P<0.01) and reduced hospitalization time during the 5 study days (P<0.01) than patients given ampicillin‐sulbactam. No adverse effects were observed in the two study groups. This controlled trial showed good efficacy with cefixime compared to ampicillin‐sulbactam in the treatment of shigellosis. Single‐dose daily oral therapy with cefixime also showed good tolerability. Cefixime should be considered as an alternative drug of choice for shigellosis in children.