Death from
Shigellosis is rare in developed countries, however it causes over a million deaths in developing countries worldwide annually. Death from
shigellosis is rare in Fiji. However, the global problem of emerging multidrug resistance raises some issues about the management of
Shigellosis in this country. Within Fiji, Shigella is a notifiable disease. The Fiji Ministry of Health recorded 68 cases of Shigella in 1996, 173 cases in 1997 and 334 cases in 1998 (no data available for 1999). There was only one recorded death during this time--in 1998. Resistance to
chloramphenicol occurred in 82% of cases. Shigella flexneri in Fiji remains sensitive to
cephalothin and
cefaclor. The current
antibiotic guidelines in Fiji, recommend that
antibiotics be used only for cases of moderate and severe
dysentery.
Shigellosis was suspected soon after presentation however the patient was unable to take oral
antibiotics and was treated with intravenous
antibiotics (
chloramphenicol and
ampicillin), which were ineffective due to resistance of the organism. The current
antibiotic guidelines for severe
dysentery recommend
chloramphenicol or
nalidixic acid--the later not available in Fiji. However the only intravenous drugs that retain their sensitivity to Shigella-
ceftriaxone and
cephalothin, are expensive ($F 45.00 per vial of
ceftriaxone) and these are only available in large regional hospitals.