Increasing antimicrobial resistance of enteric pathogens represents a significant barrier to
therapy for bacterial
enteritis and, to a lesser extent,
typhoid fever. Poor study design limits the value of many of the clinical trials that suggest
drug efficacy. Studies are often not placebo-controlled, randomized, or blind comparative trials; clinical criteria for response are frequently not stated; and the numbers of subjects are small. Among the known therapeutic principles for choosing drugs for enteric
infections is that the agent be active in vitro against the isolate, that for treating
infections due to invasive pathogens both lumenal and tissue levels be adequate, that drugs with good enterohepatic circulation may be especially well suited for the treatment of
infections due to noninvasive pathogens, and that drugs active intracellularly may have particular value in
therapy for
typhoid, especially in reducing the relapse rate. The new
4-quinolones are not only highly active in vitro against a broad range of enteric pathogens but generally also exhibit most of the other properties desirable for the treatment of these
infections. Although further clinical trials are necessary to assess the comparative efficacy of the
quinolones, the present clinical data already indicate that they will be of great utility, and particularly important in the treatment of
drug-resistant
shigellosis, which is currently a major problem in many developing nations in Asia and Africa.