Resistance in Shigella spp. and Modern Approaches to Antimicrobial Therapy of Shigellosis | CMAC

Resistance in Shigella spp. and Modern Approaches to Antimicrobial Therapy of Shigellosis

Clinical Microbiology and Antimicrobial Chemotherapy. 2005; 7(4):350-368

​ Maleev V.V., Ivanov A.S., Stratchounski L.S.
shigellosis Shigella spp antimicrobial resistance antimicrobial therapy
Section
Antimicrobial Resistance
Type
Journal article
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2005; 7(4):350-368

Abstract

A variety of resistance mechanisms and free transfer of resistance genes whithin a gender as well as among Enterobacteriaceae lead to a number of problems in the choice of antibacterial therapy of shigellosis. Many conventional antimicrobials used for treatment of shigellosis such as ampicillin, co-trimoxazole and tetracyclynes lost their activity. The role of the different classes of antimicrobials in the treatment of shigellosis is discussed in this review.

  • 1. Kotloff K.L., Winickoff J.P., Ivanoff B., et al. Global burden of Shigella infections: implications for vaccine development and implementation of control strategies. Bull WHO 1999; 77:651-66.
  • 2. Navia M.M., Capitano L., Ruiz J., Vargas M., et al. Typing and characterization of mechanisms of resistance of Shigella spp. Isolated from feces of children under 5 years of age from Ifakara, Tanzania. J Clin Microbiol 1996; 37:3113-7.
  • 3. Mates A., Eyny D., Philo S. Antimicrobial resistance trends in Shigella serogroups isolated in Israel, 1990-1995. Eur J Clin Microbiol Infect Dis 2000; 19:108-11.
  • 4. Prats G., Mirelis B., Llovet T., et. al. Antibiotic resistance trends in enteropathogenic bacteria isolated in 1985-1987 and 1995-1998 in Barcelona. Antimicrob Agents Chemother 2000; 44:1140-5.
  • 5. Replogle M.L., Fleming D.W., Cieslak P.R. Emergence of antimicrobial-resistant shigellosis in Oregon. Clin Infect Dis 2000; 30:515-9.
  • 6. Thielman N. M., Guerrant R. L. Acute infectious diarrhea. N Engl J Med 2004; 350:38-47.
  • 7. Федеральный центр Госсанэпиднадзора МЗ РФ. Инфекционная заболеваемость в Российской Федерации в 2003-2004 гг. Справка о состоянии инфекционной заболеваемости за 12 месяцев 2004 года. 07 февраля 2005 г. Доступно с URL: http://www.fcqsen.ru.
  • 8. Cheasty T., Skinner J.A., Rowe B., Threlfall E.J. Increasing incidence of antibiotic resistance in Shigellas from humans in England and Wales: recommendations for therapy. Microb Drug Resist 1998; 4:57-60.
  • 9. Khalil K., Khan S.R., Mazhar K., Kaijser B., Lindblom G.B. Occurrence and susceptibility to antibiotics of Shigella species in stools of hospitalized children with bloody diarrhea in Pakistan. Am J Trop Med Hyg 1998; 58:800-3.
  • 10. Kim S., Kim J., Jang H., Kang Y., Lee B. Review of antimicrobial resistance of Shigella flexneri isolated in Korea during 1998 to 2002. Proceedings of the 1st FEMS Congress; Ljubljana, Slovenia; 2003. Poster P6-7.
  • 11. Suarez M. E., Carvajal L., Culasso C., Paredes M. Antimicrobial resistance of Shigella spp. in Cordoba, Argentina, during the period 1990-1997. Rev Panam Salud Publica 2000; 7:113-7.
  • 12. Ashkenazi S., Levy I., Kazaronovski V., Samra Z. Growing antimicrobial resistance of Shigella isolates. J Antimicrob Chemother 2003; 51:427-9.
  • 13. Aysev A.D., Guriz H. Drug resistance of Shigella strains isolated in Ankara, Turkey, 1993-1996. Scand J Infect Dis 1998; 30:351-3.
  • 14. Рафальский В.В., Андреева И.В., Веселов А.В. Характеристика потенциальных слушателей курсов дистанционного образования по антимикробной терапии. V Международная конференция МАКМАХ: Тезисы докладов; М.; 2002. С. 36-37.
  • 15. Phavichitr N., Catto-Smith A.G. Acute gastroenteritis in children. What role for antibacterials? Pediatr Drugs 2003; 5:279-90.
  • 16. Gomez H.F., Cleary T.G. Shigella species. In: Long S.S., Pickering L.K., Prober C.G., eds. Principles and Practice of Pediatric Infectious Diseases. Philadelphia: Churchill Livingstone; 2003. p. 836-9.
  • 17. Bratoeva M.P., John J.F. Jr. In vivo R-plasmid transfer in a patient with a mixed infection of Shigella dysentery. Epidemiol Infect 1994; 112:247-52.
  • 18. Oh J.Y., Yu H.S., Kim S.K., Seol S. Y., Cho D. T., Lee J. C. Changes in patterns of antimicrobial susceptibility and integron carriage among Shigella sonnei isolates from Southwestern Korea during epidemic periods. J Clin Microbiol 2003; 41:421-3.
  • 19. Козлова Н. С. Плазмиды антибиотикорезистентных штаммов шигелл, выделенных в Ленинграде и Ленинградской области. Антибиот химиотер 1993; 38(4-5):9-13.
  • 20. O’Hara K., Haruta S., Sawai T., Tsunoda M., Iyobe S. Novel metallo �-lactamase mediated by a Shigella flexneri plasmid. FEMS Microbiol Lett 1998; 162:201-6.
  • 21. Ambler J. E., Drabu Y. J., Blakemore P. H., Pinney R. J. Mutator plasmid in a nalidixic acid-resistant strain of Shigella dysenteriae type 1. J Antimicrob Chemother 1993; 31:831-9.
  • 22. Rajakumar K., Bulach D., Davies J., Ambrose L., Sasakawa C., Adler B. Identification of a chromosomal Shigella flexneri multi-antibiotic resistance locus which shares sequence and organizational similarity with the resistance region of the plasmid NR1. Plasmid 1997; 37:159-68.
  • 23. Siu L.K., Lo J.Y.C., Yuen K.Y., Chau P.Y., Ng M.H., Ho P.L. β-Lactamases in Shigella flexneri isolates from Hong Kong and Shanghai and novel OXA-1-like β-lactamase, OXA-30. Antimicrob Agents Chemother 2000; 44:2034– 8.
  • 24. Fortineau N., Naas T., et al. SHV-type extended-spectrum β-lactamase in a Shigella flexneri clinical Isolate. J Antimicrob Chemother 2001; 47:685-8.
  • 25. Ahamed J., Kundu M. Molecular characterization of the SHV-11 β-lactamase of Shigella dysenteriae. Antimicrob Agents Chemother 1999; 43:2081-3.
  • 26. Nuesch-Inderbinen M. T., Kayser F. H., Hachler H. Survey and molecular genetics of SHV β-lactamases in Enterobacteriaceae in Switzerland: two novel enzymes, SHV-11 and SHV-12. Antimicrob Agents Chemother 1997; 41:943-9.
  • 27. Lindberg F., Normark S. Contribution of chromosomal beta-lactamases to beta-lactam resistance in enterobacteria. Rev Infect Dis 1986; 8(Suppl 3):S292-304.
  • 28. Odeh R., Kelkar S., Hujer A. M., Bonomo R. A., Schreckenberger P. C., Quinn J. P. Broad resistance due to plasmid-mediated AmpC β-lactamases in clinical isolates of Escherichia coli. Clin Infect Dis 2002; 35:140-5.
  • 29. Ghosh A.S., Kar A.K., Kundu M. Alterations in high molecular mass penicillin-binding protein 1 associated with beta-lactam resistance in Shigella dysenteriae. Biochem Biophys Res Commun 1998; 248:669-72.
  • 30. Ahamed J., Gangopadhyay J., Kundu M., Sinha A. K. Mechanisms of quinolone resistance in clinical isolates of Shigella dysenteriae. Antimicrob Agents Chemother 1999; 43:2333-4.
  • 31. Chu Y.-W., Houang E.T.S., Cheng A.F.B. Novel combination of mutations in the DNA gyrase and topoisomerase IV genes in laboratory-grown fluoroquinolone-resistant Shigella flexneri mutants. Antimicrob Agents Chemother 1998; 42:3051-2.
  • 32. Everett M.J., Jin Y.F., Ricci V., Piddock L.J.V. Contributions of individual mechanisms to fluoroquinolone resistance in 36 Escherichia coli strains isolated from humans and animals. Antimicrob Agents Chemother 1996; 40:2380-6.
  • 33. Rahman M., Mauff G., Levy J., Couturier M., Pulverer G., Glasdorff N., Butzler J. P. Detection of 4-quinolone resistance mutation in gyrA gene of Shigella dysenteriae type 1 by PCR. Antimicrob Agents Chemother 1994; 38:2488-91.
  • 34. Ghosh A.S., Ahamed J., Chauhan K.K., Kundu M. Involvment of an efflux system in high-level fluoroquinolone resistance of Shigella dysenteriae. Biochem Biophys Res Commun 1998; 242:54-6.
  • 35. Martinez-Martinez L., Pascual A., Jacoby G. A. Quinolone resistance from a transferable plasmid. Lancet 1998; 351:797-9.
  • 36. Courvalin P. Plasmid-mediated 4-quinolone resistance: a real or apparent absence? Antimicrob Agents Chemother 1990; 34:681-4.
  • 37. Farfan M., Flores O., Navarro N., Prado V., Mora G., Toro C. Molecular characterization of resistance mechanisms to chloramphenicol in Shigella flexneri strains isolated from Chilean children with acute diarrhea. Rev Med Chil 2002; 130:275-80.
  • 38. Bryskier A. Nouvelles tetracyclines. In: Bryskier A., ed. Antibiotiques Agents Antibacteriens et Antifongiques. Paris: Ellipses Edition Marketing S.A., 1999. p. 669-82.
  • 39. Roberts M. C. Epidemiology of tetracycline-resistance determinants. Trends Microb 1994; 2:353-7.
  • 40. Veyssier P. Inhibiteurs de la dihydrofolate reductase, nitroheterocycles (furanes) et 8-hydroxyquinoleines. In: Bryskier A., ed. Antibiotiques Agents Antibacteriens et Antifongiques. Paris: Ellipses Edition Marketing S.A., 1999. p. 995-1029.
  • 41. Mandell G.L., Sande M.A. Antimicrobial agents: sulfonamides, trimethoprim-sulfamethoxazole, quinolones and agents for urinary tract infections. In: Goodman R., Gilman A., Rall T.W., Nies A.S., Taylor P., eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 8-th ed. New York: Pergamon Press; 1990. p. 1047-64.
  • 42. Yuce A., Gulay Z., Mehr M. A., Amyes S. G., Cakir N., Yulug N. Transferable trimethoprim resistance in Shigella strains. J Chemother 1998; 10:221-4.
  • 43. Stock I., Wiedemann B. Natural antibiotic susceptibility of Escherichia coli, Shigella, E.vulneris, and E.hermannii strains. Diagn Microbiol Infect Dis 1999; 33:187-99.
  • 44. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing: eleventh informational supplement. Approved Standard. NCCLS Document M100-S11 2001; 21(1).
  • 45. Chu Y.-W., Houang E. T. S., Lyon D. J., Ling J. M., Ng T. K., Cheng A. F. B. Antimicrobial resistance in Shigella flexneri and Shigella sonnei in Hong Kong, 1986 to 1995. Antimicrob Agents Chemother 1998; 42:440-3.
  • 46. Radice M., Gonzalez C., Power P., del Carmen Vidal M., Gutkind G. Third-generation cephalosporin resistance in Shigella sonnei, Argentina. Emerg Infect Dis 2001; 7:442-3.
  • 47. Threlfall E.J., Graham A., Cheasty T., Ward L.R., Rowe B. Resistance to ciprofloxacin in pathogenic Enterobacteriaceae in England and Wales in 1996. J Clin Pathol 1997; 50:1027-8.
  • 48. Biedenbach D., Stephen J., Jones R.N. Occurrence and susceptibility profiles of pathogens causing gastroenteritis in North America and Europe: report from SENTRY antimicrobial surveillance program. Proceedings of the 42th ICAAC; San Diego, USA; 2002. Abstract C2-308.
  • 49. Voogd C.E., Schot C.S., van Leeuwen W.J., van Klingeren B. Monitoring of antibiotic resistance in shigellae isolated in The Netherlands 1984-1989. Eur J Clin Microbiol Infect Dis 1992; 11:164-7.
  • 50. Yurdakok K., Sahin N., Ozmert E., Berkman E. Shigella gastroenteritis: clinical and epidemiological aspects, and antibiotic susceptibility. Acta Paediatr Jpn 1997; 39:681-4.
  • 51. Jones R.N., Dudley M.N. Microbiologic and pharmacodynamic principals applied to the antimicrobial susceptibility testing of ampicillin/sulbactam: analysis of the correlations between in vitro test results and clinical response. Diagn Microbiol Infect Dis 1997; 28:5-18.
  • 52. Mandell L.A., Peterson L.R., Wise R., et al. The battle against emerging antibiotic resistance: should fluoroquinolones be used to treat children? Clin Infect Dis 2002; 35:721-7.
  • 53. Semenov V.M., Dmitrachenco T.I., Azarionok M.K., Zhyitsou I.V. Susceptibility of Shigellas found on the territory of Belarus to antibiotics. Proceedings of the 21th ICC; Birmingham, UK; 1999. Abstract P239.
  • 54. Лучшев В.И., Шахмарданов М.З., Пирцхалаишвилли Г.Г. Антибактериальная терапия шигеллеза Флекснера. VII Российский национальный конгресс «Человек и лекарство»: Тезисы докладов. М., 2001. C. 234.
  • 55. Guerrant R.L., Gilder T.V., Steiner T.S., et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis 2001; 32:331-50.
  • 56. Islam M.R., Alam A.N., Hossain M.S., Mahalanabis D., Hye H.K. Double-blind comparison of oral gentamicin and nalidixic acid in the treatment of acute shigellosis in children. J Trop Pediatr 1994; 40:320-5.
  • 57. Бенниш М. Бактериальные диареи у детей: синдромная или этиотропная терапия? Клин микробиол антимикроб химиотер 2000; 2:57-60.
  • 58. Bennish M.L., Khan W.A., Seas C., Salam M.A., Dhar U. Azithromycin in the treatment of shigellosis. A collection of key scientific posters. Proceedings of the 5th International Conference on the Macrolides, Azalides, Streptogramins, Ketolides & Oxazolidinones; Seville, Spain; 2000. Abstract 05.16.
  • 59. Khan W.A., Seas C., Dhar U., Salam M.A., Bennish M.L. Treatment of shigellosis: V. Comparison of azithromycin and ciprofloxacin. A double-blind, randomized, controlled trial. Ann Intern Med 1997; 126:697-703.
  • 60. Rakita R.M., Jacques-Palaz K., Murray B.E. Intracellular activity of azithromycin against bacterial enteric pathogens. Antimicrob Agents Chemother 1994; 38:1915-21.
  • 61. Haltalin K.C., Nelson J.D., Hinton L.V., Kusmiesz H.T., Sladoje M. Comparison of orally absorbable and nonabsorbable antibiotics in shigellosis. J Pediatr 1968; 72:708-20.
  • 62. Haltalin K.C., Nelson J.D., Kusmicsz H.T., Hinton L.V. Comparison of intramuscular and oral ampicillin therapy for shigellosis. J Pediatr 1968; 73:617-22.
  • 63. Nelson J.D., Haltalin K.C. Amoxicillin less effective than ampicillin against Shigella in vitro and in vivo: relationship of efficacy to activity in serum. J Infect Dis 1974; 129(Suppl):S222-S7.
  • 64. Bennish M. L., Salam M. A., Haider R., Barza M. Therapy for shigellosis: II. Randomized, double-blind comparison of ciprofloxacin and ampicillin. J Infect Dis 1990; 162:711-6.
  • 65. Barr W.H., Zola E.M., Candler E.L., et al. Differential absorption of amoxicillin from the human small and large intestine. Clin Pharmacol Ther 1994; 56:279-85.
  • 66. Lister P.D., Prevan A.M., Sanders C.C. Importance of beta-lactamase inhibitor pharmacokinetics in the pharmacodynamics of inhibitor-drug combinations: studies with piperacillin-tazobactam and piperacillin-sulbactam. Antimicrob Agents Chemother 1997; 41:721-7.
  • 67. Helvaci M., Bektaslar D., Ozkaya B., et al. Comparative efficacy of cefixime and ampicillin-sulbactam in shigellosis in children. Acta Paediatr Jpn 1998; 40:131-4.
  • 68. Ashkenazi S., Amir J., Waisman Y., et al. A randomized, double-blind study comparing cefixime and trimetho prim-sulfamethoxazole in the treatment of childhood shigellosis. J Pediatr 1993; 123:817-21.
  • 69. Martin J. M., Pitetti R., Maffei F., et al. Treatment of shigellosis with cefixime: two days vs. five days. Pediatr Infect Dis J 2000; 19:522-6.
  • 70. Moolasart P., Eampokalap B., Ratanasrithong M. Comparison of the efficacy of ceftibuten and norfloxacin in the treatment of acute gastrointestinal infection in children. Southeast Asian J Trop Med Public Health 1999; 30:764-9.
  • 71. Prado D., Lopez E., Liu H., et al. Ceftibuten and trime thoprim-sulfamethoxazole for treatment of Shigella and enteroinvasive Escherichia coli disease. Pediatr Infect Dis J 1992; 11:644-7.
  • 72. Salam M.A., Seas C., Khan W.A., Bennish M.L. Treatment of shigellosis: IV. Cefixime is ineffective in shigellosis in adults. Ann Intern Med 1995; 123:505-8.
  • 73. Basualdo W., Arbo A. Randomized comparison of azithromycin versus cefixime for treatment of shigellosis in children. Ped Inf Dis J 2003; 22:374-77.
  • 74. Eidlitz-Marcus T., Cohen Y. H., Nussinovitch M., Elian I., Varsano I. Comparative efficacy of two- and five-day courses of ceftriaxone for treatment of severe shigellosis in children. J Pediatr 1993; 123:822-4.
  • 75. Varsano I., Eidlitz-Marcus T., Nussinovitch M., Elian I. Comparative efficacy of ceftriaxone and ampicillin for treatment of severe shigellosis in children. J Pediatr 1991; 118(4 Pt 1):627-32.
  • 76. Leibovitz E., Janco J., Piglansky L., et al. Oral ciprofloxacin vs. intramuscular ceftriaxone as empiric treatment of acute invasive diarrhea in children. Pediatr Infect Dis J 2000; 19:1060-7.
  • 77. Hoffman J.A., Kim K.S. Failure of cefotaxime therapy in a child with shigellosis [letter]. Pediatr Infect Dis J 1996; 15:175-6.
  • 78. Chalumeau M., Tonnelier S., Treluyer J. M., et al. Fluoroquinolones safety in pediatric patients: a prospective multicentric controlled cohort study in France. Proceedings of the 42th ICAAC; San-Diego, USA; 2002. Abstract G-441.
  • 79. Fish D.N. Fluoroquinolone adverse effects and drug interactions. Pharmacotherapy 2001; 21(Suppl 10): 253s-72s.
  • 80. Ball P., Mandell L., Niki Y., Tillotson G. Comparative tolerability of the newer fluoroquinolone antibacterials. Drug Saf 1999; 21:407-21.
  • 81. Danisovicova A., Brezina M., Belan S., et al. Magnetic resonance imaging in children receiving quinolones: no evidence of quinolone-induced arthropathy. A multicenter survey. Chemother 1994; 40:209-14.
  • 82. ZIMBASA dysentery study group. Multicenter, randomized, double blind clinical trial of short course versus standard course oral ciprofloxacin for Shigella dysenteriae type 1 dysentery in children. Pediatr Infect Dis J 2002; 21:1136-41.
  • 83. Gotuzzo E., Oberhelman R. A., Maguina C., et al. Comparison of single-dose treatment with norfloxacin and standard 5-day treatment with trimethoprim-sulfametho xazole for acute shigellosis in adults. Antimicrob Agents Chemother 1989; 33:1101-4.
  • 84. Bhattacharya K., Bhattacharya M. K., Dutta D., et al. Double-blind, randomized clinical trial for safety and efficacy of norfloxacin for shigellosis in children. Acta Paediatr 1997; 86:319-20.
  • 85. Salam M. A., Dhar U., Khan W. A., Bennish M. L. Randomised comparison of ciprofloxacin suspension and pivmecillinam for childhood shigellosis. Lancet 1998; 352:522-7.
  • 86. Yee C.L., Duffy C., Gerbino P.G., Stryker S., Noel G.J. Tendon or joint disorders in children after treatment with fluoroquinolones or azithromycin. Pediatr Infect Dis J 2002; 21:525-9.
  • 87. Jick S. Ciprofloxacin safety in a pediatric population. Pediatr Infect Dis J 1997; 16:130-4.
  • 88. Bennish M.L., Salam M. A., Khan W.A., Khan A.M. Treatment of shigellosis: III. Comparison of one- or two-dose ciprofloxacin with standard 5-day therapy. A randomized, blinded trial. Ann Intern Med 1992; 117:727-34.
  • 89. Casellas (Jr) J.M., Casellas (Sr) J.M., Espinola C., et al. Azithromycin activity against 100 Shigella spp. Strains isolated from paediatric patients in Argentina and Paraguay as compared to that of other antibacterial agents. A collection of key scientific posters. Proceedings of the 5th International Conference on the Macrolides, Azalides, Streptogramins, Ketolides & Oxazolidinones; Seville, Spain; 2000. Abstract 01.22.
  • 90. Retsema J.A., Girard A.E., Girard D., Milisen W.B. Relationship of high tissue concentrations of azithromycin to bactericidal activity and efficacy in vivo. J Antimicrob Chemother 1990; 25(Suppl A):83-9.
  • 91. Новокшонов А. А., Мазанкова Л.Н., Соколова Н. В. Патогенетическое обоснование оптимальной терапии острых кишечных инфекций у детей. Детские инфекции 2002; (1):32-7.
  • 92. Шувалова Е. П., Беляева Т. В., Осипова Г. И. Клиническая диагностика и терапия дизентерии. Рос журнал гастроэнтерол гепатол колопроктол 1997; (5):60-6.
  • 93. Ito K., Ishida K., Takeuchi A., Nii A., Okamiya H., Doi K. Nitrofurazone induces non-regenerative hepatocyte proliferation in rats. Exp Toxicol Pathol 2002; 53:421-6.
  • 94. Клинические наблюдения. Фуразолидон: нарушение функции печени у ребенка двух месяцев. Медицинская газета 2002 16 янв.
  • 95. Rodriguez R. S., Chavez A. Z., Galindo E. A randomized, controlled, single-blind study comparing furazolidone with trimethoprim-sulfamethoxazole in the empirical treatment of acute invasive diarrhea. Scand J Gastroenterol 1989; 169(Suppl):47-53.
  • 96. Nifuroxazide in acute diarrhoea: OTC preparation. Irrational. Prescrire Int 1999; 8:170-2.
  • 97. Dutta P., Sett A., Sarkar A., et al. Comparative efficacy of furazolidone and nalidixic acid in the empirical treatment of acute invasive diarrhea: randomized clinical trial. Indian Pediatr 1995; 32:13-9.
  • 98. Quillardet P., Michel V., Arrault X., Hofnung M., Touati E. Mutagenic properties of a nitrofuran, 7-methoxy- 2-nitronaphtho[2,1-b]furan (R7000), in lacI transgenic mice. Mutat Res 2000; 470:177-88.
  • 99. Sande M.A., Mandell G.L. Antimicrobial agents: the aminoglycosides. In: Goodman Gilman A., Rall T.W., Nies A.S., Taylor P., eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8-th ed. New York: Pergamon Press; 1990. p. 1098-116.
  • 100. Wistrom J., Jertborn M., Ekwall E., et al. Empiric treatment of acute diarrheal disease with norfloxacin. A randomized, placebo-controlled study. Swedish Study Group. Ann Intern Med 1992; 117:202-8.
  • 101. Kabir I., Rahaman M.M., Ahmed S.M., et al. Comparative efficacies of pivmecillinam and ampicillin in acute shigellosis. Antimicrob Agents Chemother 1984; 25:643-5.
  • 102. Vinh H., Wain J., Chinh M.T., Tam C.T., et al. Treatment of bacillary dysentery in Vietnamese children: two doses of ofloxacin versus 5-days nalidixic acid. Trans R Soc Trop Med Hyg 2000; 94:323-6.
  • 103. Alam A.N., Islam M.R., Hossain M.S., Mahalanabis D., Hye H. K. Comparison of pivmecillinam and nalidixic acid in the treatment of acute shigellosis in children. Scand J Gastroenterol 1994; 29:313-7.
Views
0 Abstract
0 PDF
0 Crossref citations
Shared