Shigellosis: high rates of antibiotic resistance necessitate new treatment recommendations

Jeremy Brown, Simon J Willcox, Neil Franklin, Briony Hazelton and Matthew VN O'Sullivan
Med J Aust 2016; 204 (7): . || doi: 10.5694/mja15.01176
Published online: 18 April 2016

Shigella species cause a potentially severe diarrhoeal illness that is frequently travel-associated and is both foodborne and sexually acquired. There is evidence of increasing antibiotic resistance in Shigella isolates from international studies.1,2 However, there is limited published research on this issue in an Australian context. The current Australian Therapeutic Guidelines recommend either co-trimoxazole or quinolone therapy for suspected or proven shigellosis, but do comment that quinolone resistance is increasing in developing countries and recommend azithromycin as an alternative option, if required.3 Successful treatment of shigellosis reduces the duration of illness and infectivity.

  • 1 Centre for Infectious Disease and Microbiology - Public Health, Westmead Hospital, Sydney, NSW
  • 2 NSW Health, Sydney, NSW


We acknowledge the contribution of surveillance officers in NSW public health units, and Nectarios Rose from Health Protection NSW for his assistance in extracting data from NCIMS. We also thank Peter Howard from the Enteric Reference Laboratory at the ICPMR. This work was completed while Simon Willcox was employed as trainee on the NSW Public Health Training Program funded by the NSW Ministry of Health.

Competing interests:

No relevant disclosures.

  • 1. Gu B, Cao Y, Pan S, et al. Comparison of the prevalence and changing resistance to nalidixic acid and ciprofloxacin of Shigella between Europe–America and Asia–Africa from 1998 to 2009. Int J Antimicrob Agents 2012; 40: 9-17.
  • 2. Bowen A, Hurd J, Hoover C, et al. Importation and domestic transmission of Shigella sonnei resistant to ciprofloxacin — United States, May 2014–February 2015. MMWR Morb Mortal Wkly Rep 2015; 64: 318-320.
  • 3. Therapeutic Guidelines. Shigella enteritis (shigellosis). (accessed Aug 2015).
  • 4. Boumghar-Bourtchai L, Mariani-Kurkdjian P, Bingen E, et al. Macrolide-resistant Shigella sonnei. Emerg Infect Dis 2008; 14: 1297-1299.
  • 5. Clinical and Laboratories Standards Institute. Document M100-S26: performance standards for antimicrobial susceptibility testing. Wayne, PA: CLSI, 2016.


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