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Antibiotic regimens for Shigella in children <18 years of age[1-6]

Antibiotic regimens for Shigella in children <18 years of age[1-6]
Antibiotic Regimen Maximum daily dose Comments
Parenteral agents for empiric or targeted therapy
Ceftriaxone (preferred) 50 mg/kg IV or IM once daily for 5 days 1.5 g/day
  • 2 days of treatment may be sufficient for immunocompetent children without bacteremia who are afebrile after 2 days
Ciprofloxacin 20 mg/kg per day IV divided in 2 doses for 3 to 5 days 800 mg/day
  • For children <18 years: Use only if no other safe and effective alternative available
  • Dose needs to be adjusted in setting of decreased/decreasing GFR
Oral agents for empiric or targeted therapy
Azithromycin
(preferred)		 12 mg/kg orally once daily on day 1; 6 mg/kg orally once daily for 2 to 4 days (total duration 3 to 5 days) 500 mg/day on the first day;
250 mg/day on subsequent days
  • Preferred unless Shigella was acquired in South Asia (eg, India, Pakistan, Bangladesh)
Cefixime 8 mg/kg per day orally in 1 or 2 divided doses for 3 to 5 days 400 mg/day
  • Preferred for Shigella acquired in South Asia (eg, India, Pakistan, Bangladesh)
Ceftibuten 9 mg/kg orally once daily for 3 to 5 days 400 mg/day
  • Preferred for Shigella acquired in South Asia (eg, India, Pakistan, Bangladesh)
Ciprofloxacin 20 mg/kg per day orally in 2 divided doses for 3 to 5 days 1.5 g/day
  • For children <18 years: Use only if no other safe and effective alternative available
  • Dose needs to be adjusted in setting of decreased/decreasing GFR
Norfloxacin
(not available in the United States)		 10 to 15 mg/kg per day orally in 2 divided doses for 3 to 5 days 800 mg/day
  • For children <18 years: Use only if no other safe and effective alternative available
  • Dose needs to be adjusted in setting of decreased/decreasing GFR
Pivmecillinam
(not available in the United States)		 45 to 60 mg/kg per day orally in 3 or 4 divided doses for 3 to 5 days 900 mg/day  
Oral agents primarily for targeted therapy
Ampicillin 100 mg/kg per day orally in 4 divided doses for 3 to 5 days 2 g/day
  • Use only if:
  • The isolated strain is susceptible, or
  • Local microbiologic data suggest susceptibility
Nalidixic acid
(not available in the United States)		 55 mg/kg per day orally divided in 4 doses for 3 to 5 days 4 g/day
  • For children <18 years: Use only if no other safe and effective alternative available
  • Use only if:
  • The isolated strain is susceptible, or
  • Local microbiologic data suggest susceptibility
  • Dose needs to be adjusted in setting of decreased/decreasing GFR
Trimethoprim-sulfamethoxazole
(Co-trimoxazole, TMP-SMX)		 10 mg/kg (based upon TMP component) orally in 2 divided doses for 3 to 5 days 320 mg TMP/day
  • Use only if:
  • The isolated strain is susceptible, or
  • Local microbiologic data suggest susceptibility
This table is meant for use with UpToDate content on treatment of shigella infections in children. Refer to UpToDate content for additional details, including choice of therapy and follow-up.
IV: intravenous; IM: intramuscular; GFR: glomerular filtration rate.
References:
  1. American Academy of Pediatrics. Shigella infections. In: Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, Itasca, IL 2021. p.668.
  2. Eidlitz-Marcus T, Cohen YH, Nussinovitch M, et al. Comparative efficacy of two- and five-day courses of ceftriaxone for treatment of severe shigellosis in children. J Pediatr 1993; 123:822.
  3. Jackson MA, Schutze GE, Committee on Infectious Diseases. The use of systemic and topical fluoroquinolones. Pediatrics 2016; 138.
  4. Martin JM, Pitetti R, Maffei F, et al. Treatment of shigellosis with cefixime: Two days vs. five days. Pediatr Infect Dis J 2000; 19:522.
  5. Salam MA, Dhar U, Khan WA, Bennish ML. Randomised comparison of ciprofloxacin suspension and pivmecillinam for childhood shigellosis. Lancet 1998; 352:522.
  6. Basualdo W, Arbo A. Randomized comparison of azithromycin versus cefixime for treatment of shigellosis in children. Pediatr Infect Dis J 2003; 22:374.
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