***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 prospect i ve r and omized 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 A single-blind , parallel , r and omized study comparing the efficacy of furazolidone and ampicillin in the treatment of children with acute invasive diarrhea  was conducted among out patients at the Hospital General de Ciudad Nezahualcoyotl in Mexico between August 1986 and October 1987 . Seventy-eight patients were admitted to the study ; 39 were r and omized to receive furazolidone ( 5 mg/kg/day for 5 days ) , and 39 were r and omized to receive ampicillin ( 100 mg/kg/day for 5 days ) . The enteropathogens Shigella sp , Salmonella sp , and Escherichia coli were isolated in 87.2 % of the initial stool cultures . A preliminary assessment of the patients ' clinical status was made on day 3 . At that time 97.4 % of furazolidone patients had improved , compared with 65.7 % of patients in the ampicillin group ( p = 0.002 ) . At the end of the treatment period ( day 6 ) , 100 % of evaluable patients treated with furazolidone had a negative stool culture , compared with 71 % of evaluable patients treated with ampicillin ( p = 0.002 ) . Both absence of watery stools by day 5 and a negative day 6 stool culture determined treatment success . Overall , there was a greater percentage of treatment successes in the furazolidone group than in the ampicillin group ( 92.3 % versus 51.3 % , p = 0.001 ) . Tolerance to both drugs was very good . One patient treated with ampicillin developed urticaria , which required discontinuation of treatment ; the reaction resolved spontaneously after treatment discontinuation . No adverse reactions were reported in the furazolidone group . The results of this study showed that furazolidone was more effective than ampicillin in the treatment of acute invasive diarrhea . It is suggested that furazolidone should be the treatment of choice for this disease Background The burden of shigellosis is greatest in re source -poor countries . Although this diarrheal disease has been thought to cause considerable morbidity and mortality in excess of 1,000,000 deaths globally per year , little recent data are available to guide intervention strategies in Asia . We conducted a prospect i ve , population -based study in six Asian countries to gain a better underst and ing of the current disease burden , clinical manifestations , and microbiology of shigellosis in Asia . Methods and Findings Over 600,000 persons of all ages residing in Bangladesh , China , Pakistan , Indonesia , Vietnam , and Thail and were included in the surveillance . Shigella was isolated from 2,927 ( 5 % ) of 56,958 diarrhoea episodes detected between 2000 and 2004 . The overall incidence of treated shigellosis was 2.1 episodes per 1,000 residents per year in all ages and 13.2/1,000/y in children under 60 months old . Shigellosis incidence increased after age 40 years . S. flexneri was the most frequently isolated Shigella species ( 1,976/2,927 [ 68 % ] ) in all sites except in Thail and , where S. sonnei was most frequently detected ( 124/146 [ 85 % ] ) . S. flexneri serotypes were highly heterogeneous in their distribution from site to site , and even from year to year . PCR detected ipaH , the gene encoding invasion plasmid antigen H in 33 % of a sample of culture-negative stool specimens . The majority of S. flexneri isolates in each site were resistant to amoxicillin and cotrimoxazole . Ciprofloxacin-resistant S. flexneri isolates were identified in China ( 18/305 [ 6 % ] ) , Pakistan ( 8/242 [ 3 % ] ) , and Vietnam ( 5/282 [ 2 % ] ) . Conclusions Shigella appears to be more ubiquitous in Asian impoverished population s than previously thought , and antibiotic-resistant strains of different species and serotypes have emerged . Focusing on prevention of shigellosis could exert an immediate benefit first by substantially reducing the overall diarrhoea burden in the region and second by preventing the spread of panresistant Shigella strains . The heterogeneous distribution of Shigella species and serotypes suggest that multivalent or cross-protective Shigella vaccines will be needed to prevent shigellosis in Asia Following a nationwide outbreak of Shigella dysentery type 1 and the recognition of Shigella isolates resistant to ampicillin , the drug of choice , we conducted a clinical trial to compare the efficacy of ampicillin v. trimethoprim-sulphamethoxazole for the treatment of Shigella dysentery . Patients with symptoms of dysentery and no other complicating illness were r and omized into one of two treatment groups . Patients in the two groups were comparable at the time of hospital admission with regard to age , sex , presenting complaints and Shigella strains . They responded well with both regimens and there was no significant difference in the mean time until stool became culture negative ( 1.4 days ) , temperatures returned to normal ( 2.7 days ) and faecal leucocytes disappeared ( 3.0 days ) ; abdominal pain , tenesmus and stool blood and mucus improved significantly more rapidly with trimethoprim-sulphamethoxazole than with ampicillin . There was no evidence of toxicity with either drug . While both drugs are effective for the treatment of Shigella dysentery , trimethoprim-sulphamethoxazole was considered to be superior BACKGROUND Shigella species infections coupled with increased levels of antimicrobial resistances are major public health problems in developing countries particularly in children . OBJECTIVES The present study was conducted to determine the prevalence and antimicrobial resistance pattern of Shigella species among patients with diarrhea at Felege Hiwot Referral Hospital . METHODS A cross-sectional prospect i ve study was undertaken among patients with diarrhea ( n=215 ) from August to November 2009 . A4 pre-tested structured question naire was used for collecting data . Stool sample s were investigated for identification of Shigella species following st and ard procedures and antimicrobial susceptibility tests were performed using disc diffusion technique . RESULTS The isolation rate of Shigella species was 32/215 [ 14.9 % ( 95 % CI . : 10.5 - 20.5 ) ] , with high prevalence in patents under five years of age .  Educational level , latrine usage , source of drinking water , and h and washing habits showed a statistically significant association with the prevalence of Shigella species ( p = 0.004 ) . All isolates of Shigella species were susceptible to ciprofloxacin and high level of sensitivity was observed for norfloxacin ( 90.6 % ) and gentamicin ( 75 % ) . Multiple drug resistance to as many as nine antibiotics was also detected CONCLUSION High prevalence of Shigella with multiple antibiotic resistance isolates was observed in this study . Public health workers should emphasize , on primary preventive measures and periodic surveillance for antibiotic susceptibility pattern of Shigella isolates . When culturing and antibiotic susceptibility testing facilities are not available , prescription of ciprofloxacin as a choice of treatment is recommended A prospect i ve r and omized study was conducted at an infectious disease hospital in Thail and .  Ceftibuten was compared with norfloxacin , both given orally for five days for treatment of acute gastroenteritis in children . One hundred and seventy cases were included in the study . Eighty-eight cases were treated with ceftibuten and eighty-two cases with norfloxacin . The baseline characteristics of the patients in both treatment groups were similar . The results showed that mean duration s of diarrhea in the ceftibuten and norfloxacin groups were 2.48 days and 2.29 days , respectively , but there was no statistically significant difference between the two groups ( p > 0.05 ) . There were Salmonella spp and Shigella spp isolated in both treatment groups and all were susceptible to both antibiotics . The mean duration s of Salmonella diarrhea in the ceftibuten and norfloxacin groups were 2.7 and 2.2 days , respectively , while those of Shigella diarrhea were 2.3 days and 2.0 days , respectively . There were no statistically significant differences in either comparison ( p > 0.05 ) . Neither complications nor clinical relapses were observed after both antibiotics ' treatment Background The bacterial genus Shigella is the leading cause of dysentery . There have been significant increases in the proportion of Shigella isolated that demonstrate resistance to nalidixic acid . While nalidixic acid is no longer considered as a therapeutic agent for shigellosis , the fluoroquinolone ciprofloxacin is the current recommendation of the World Health Organization . Resistance to nalidixic acid is a marker of reduced susceptibility to older generation fluoroquinolones , such as ciprofloxacin . We aim ed to assess the efficacy of gatifloxacin versus ciprofloxacin in the treatment of uncomplicated shigellosis in children . Methodology /Principal Findings We conducted a r and omized , open-label , controlled trial with two parallel arms at two hospitals in southern Vietnam . The study was design ed as a superiority trial and children with dysentery meeting the inclusion criteria were invited to participate . Participants received either gatifloxacin ( 10 mg/kg/day ) in a single daily dose for 3 days or ciprofloxacin ( 30 mg/kg/day ) in two divided doses for 3 days . The primary outcome measure was treatment failure ; secondary outcome measures were time to the cessation of individual symptoms .  Four hundred and ninety four patients were r and omized to receive either gatifloxacin ( n = 249 ) or ciprofloxacin ( n = 245 ) , of which 107 had a positive Shigella stool culture . We could not demonstrate superiority of gatifloxacin and observed similar clinical failure rate in both groups ( gatifloxacin ; 12.0 % and ciprofloxacin ; 11.0 % , p = 0.72 ) . The median ( inter-quartile range ) time from illness onset to cessation of all symptoms was 95 ( 66–126 ) hours for gatifloxacin recipients and 93 ( 68–120 ) hours for the ciprofloxacin recipients ( Hazard Ratio [ 95%CI ] = 0.98 [ 0.82–1.17 ] , p = 0.83 ) . Conclusions We conclude that in Vietnam , where nalidixic acid resistant Shigellae are highly prevalent , ciprofloxacin and gatifloxacin are similarly effective for the treatment of acute shigellosis . Trial Registration Controlled trials number IS RCT The efficacy of oral pivmecillinam was compared with nalidixic acid in the treatment of acute shigellosis in children 1 - 8 years of age . In a double-blind trial we studied 80 comparable children with bloody diarrhoea of less than 3 days ' duration . Shigella spp . was isolated in 71 children . Patients were r and omly assigned to receive either pivmecillinam , 50 mg/kg.day , or nalidixic acid , 60 mg/kg.day , both given orally for 5 days . The stool frequency decreased progressively in 
    Output:
    
No evidence of publication bias was found in this analysis of studies of diagnostic value .
INTERPRETATION Current WHO guidelines appear to manage dysentery effectively , but might miss opportunities to reduce mortality among children infected with Shigella who present without bloody stool .