ACUTE BACTERIAL DIARRHEA IN THE EMERGENCY ROOM - THERAPEUTIC IMPLICATIONS OF STOOL CULTURE RESULTS

Empiric treatment with ciprofloxacin and norfloxacin has been recommen ded recently for patients with acute diarrhoeal disease. In a retrospe ctive 6-month study period the results of stool cultures from 209 pati ents with acute diarrhoea admitted to the emergency room were analysed . Seventy-eight cultures (37%) were positive for one or more bacteria. Shigella was the most commonly isolated pathogen (68%). Shigella sonn ei comprised 72% and Shigella flexneri 19% of all the bacterial isolat es. While no antimicrobial resistance to ciprofloxacin was found for b oth Shigella species, only 36 and 26% of the Shigella isolates were se nsitive to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ), res pectively. These findings point out to the emergence of drug resistanc e to commonly used antimicrobial drugs. Shigella's high sensitivity to the newer quinolones should make this the treatment of choice for the very sick patient, although physicians should be cautioned to the fac t that indiscriminate use of this drug could result in the emergence o f resistance similar to that noted with ampicillin and TMP-SMZ.