A randomized, double-blind study comparing cefixime and trimethoprim-sulfamethoxazole in the treatment of childhood shigellosis

J Pediatr. 1993 Nov;123(5):817-21. doi: 10.1016/s0022-3476(05)80867-4.


We compared the clinical and bacteriologic response of 5-day treatment with cefixime, 8 mg/kg per day, with the response to trimethoprim-sulfamethoxazole (TMP-SMX), 10-50 mg/kg per day, the currently recommended therapy. Of the assessable children with acute, culture-proven shigellosis, 38 received cefixime and 39 received TMP-SMX. Pretreatment data on the two study groups were similar. In the first group, all isolates were susceptible to cefixime; in the TMP-SMX group, 32 isolates were resistant and 7 were susceptible to TMP-SMX. Clinical response (day 5) showed cure, improvement, and failure in 89%, 8%, and 3%, respectively, of the cefixime group, and in 25%, 44%, and 31%, respectively, of the TMP-SMX-resistant group (p < 0.001). Bacteriologic cure (day 3) occurred in 78% and 23% of the cefixime and TMP-SMX-resistant groups, respectively (p < 0.001). Clinical or bacteriologic relapse (day 12) was infrequent in both groups. The response to treatment of the cefixime and the TMP-SMX-susceptible groups was similar. No significant side effects were noted. We conclude that cefixime is superior to TMP-SMX in the treatment of suspected shigellosis in areas with a high rate of resistance to TMP-SMX.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Cefixime
  • Cefotaxime / analogs & derivatives*
  • Cefotaxime / therapeutic use
  • Child
  • Child, Preschool
  • Diarrhea, Infantile / drug therapy
  • Diarrhea, Infantile / microbiology
  • Double-Blind Method
  • Dysentery, Bacillary / drug therapy*
  • Female
  • Humans
  • Infant
  • Male
  • Prospective Studies
  • Shigella / drug effects*
  • Shigella boydii / drug effects
  • Shigella flexneri / drug effects
  • Shigella sonnei / drug effects
  • Trimethoprim Resistance
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use*


  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Cefixime
  • Cefotaxime