CDC Issues Alert on Ciprofloxacin- and Azithromycin-Nonsusceptible Shigellosis in the U.S.

The Centers for Disease Control and Prevention (CDC) continues to receive new reports of infections with Shigella strains that are not susceptible to ciprofloxacin and/or azithromycin, the antimicrobial agents most commonly used to treat shigellosis.

On June 4, 2015, the CDC issued an alert through its Health Alert Network that contained recommendations for providers and patients.

The recommendations for providers included:

  • Obtain stool cultures from patients suspected of having shigellosis.
  • Base treatment for shigellosis, when needed, on the antimicrobial susceptibility profile of the individual isolate, or during a local outbreak, that of the outbreak strain.
  • Counsel shigellosis patients about the importance of meticulous handwashing after using the toilet, and avoiding activities most likely to transmit the infection to others, such as preparing food for others, swimming, group play among young children, and certain sexual activities.
  • Recommend symptomatic contacts of shigellosis patients, particularly those suspected to have a multidrug-resistant strain, seek health care.

For shigellosis patients with treatment failure or prolonged diarrhea, obtain follow-up stool cultures at short intervals (e.g., semi-weekly) until the patient has a negative culture. Shedding of multidrug-resistant shigellae in feces may be prolonged, particularly if the patient was treated with an antimicrobial medication to which the isolate was resistant. Confirming clearance of shigellae from stool will allow more accurate counseling about the timelines appropriate for return to higher-risk activities.
Earlier this year on April 1, the Pennsylvania Department of Health (DOH) issued an alert to physicians in southwestern and northwestern Pennsylvania, saying that the Allegheny County Health Department (ACHD) was investigating an outbreak of Shigellosis linked to daycare facilities in Allegheny County. The alert cited that an unusually high number of cases had been reported to the ACHD since last October. Increases in shigellosis also have been observed in surrounding counties in southwestern Pennsylvania.
An April 3 article in the Philadelphia Inquirer said there had also been six patients in Philadelphia who had been struck by a different type of Shigella, this one an antibiotic-resistant bug, during a 10-month period ending in February. Nationally, that number was at least 243.