What to Know About Antibiotic-Resistant Shigella Superbug

The recent outbreak of a drug-resistant strain of shigellosis is giving pharmacists an important role in preventing and treating the gastrointestinal disease.

Caused by Shigella sonnei bacteria, shigellosis results in watery or bloody diarrhea, abdominal pain, fever, and malaise. While it is rarely fatal, it can cause a week’s worth of illness and potentially lead to hospitalization.

Shigellosis is primarily spread through the oral-fecal route and is extremely contagious, capable of developing from as few as 10 germs, Anna Bowen, MD, MPH, a medical officer in the US Centers for Disease Control and Prevention’s Waterborne Diseases Prevention Branch, told Pharmacy Times in an exclusive interview.

“Invisible amounts of stool on surfaces are enough to cause transmission,” Dr. Bowen told Pharmacy Times. “It spreads easily among children where access to hygiene facilities is not ideal. It’s also easy for food handlers who don’t wash their hands thoroughly to get it into food, and there have been outbreaks related to swimming facilities.”

With approximately 500,000 cases reported in the United States every year, shigellosis is not a new disease. However, the recent strain has proven to be exceptionally resilient to antibiotic treatment.

In previous years, only 2% of Shigella infections were deemed resistant to ciprofloxacin, the most common antibiotic used to treat shigellosis; however, ciprofloxacin resistance was found to occur in 90% of infections related to the current strain, Dr. Bowen said.

Dr. Bowen and her team believe the current outbreak resulted from travelers bringing new strains of the disease to the United States from countries such as India, Haiti, and the Dominican Republic.

“With how easily the Shigella spreads, it’s easy for travelers to propagate a new outbreak with this strain,” Dr. Bowen told Pharmacy Times.

Because shigellosis is frequently contracted overseas, pharmacists have an opportunity to help prevent further spread during consultations with patients planning to travel, Dr. Bowen suggested. When dispensing pre-travel medication, pharmacists should counsel patients about the elevated rate of multidrug-resistant diseases such as shigellosis in foreign countries, and also recommend they:

• Carefully wash their hands, especially before eating and after using a restroom.
• Eat only “piping hot” food, products from sealed containers, and fruits and vegetables they pealed themselves.
• Take bismuth subsalicylate (Pepto-Bismol) to prevent traveler’s diarrhea.
• Treat traveler’s diarrhea with OTCs at first, saving antibiotics for severe cases.

Patients with shigellosis should be encouraged to contact their primary care provider if their symptoms do not improve, Dr. Bowen added. Additionally, patients prescribed antibiotics that do not appear to take effect after 48 hours should request a stool sample test.

While Dr. Bowen found shigellosis’ increasing resistance to ciprofloxacin troubling, given that remaining treatment options are limited, she nevertheless encouraged pharmacists to alleviate patients’ concerns over the disease.

“If patients come with concerns, stress that it resolves on its own and that there are remaining treatment options that can be given by injection,” Dr. Bowen said.