During the last decade
quinolones such as
norfloxacin,
ciprofloxacin,
ofloxacin and
fleroxacin have emerged as drugs of choice for treatment of various bacterial enteric
infections. Controlled studies have shown that
quinolones, administered in varying regimens ranging from a single dose to 5 days treatment, significantly reduce the intensity and severity of travellers' diarrhoea as well as
shigellosis. They have also been found to be highly effective in the treatment of invasive non-
typhoid salmonellosis as well as
typhoid fever. Results from trials evaluating
quinolone treatment of uncomplicated salmonella and campylobacter
enteritis have generally been disappointing. We studied
norfloxacin for the empirical treatment of suspected bacterial
enteritis of less than 6 days duration in a large placebo controlled trial. Although statistical differences in clinical outcome favouring
norfloxacin were found among 259 culture positive patients, the differences were not striking and of doubtful clinical importance. However, a clear beneficial effect of
norfloxacin, resembling that observed in early treatment of travellers' diarrhoae was found among the severely ill patients who initiated treatment within 48 h of onset of symptoms to start of treatment seemed to be of major importance in relation to therapeutic efficacy.
Quinolone treatment of bacterial
enteritis is furthermore limited by the rapid development of resistance seen in Campylobacter spp. and the failure of these compounds to eradicate Salmonella spp. Presently
quinolones can be recommended in treatment of travellers' diarrhoea and
shigellosis as well as
enteric fever. They have limited usefulness for the routine empirical treatment of bacterial
enteritis caused by Salmonella spp and Campylobacter spp. Treatment should be restricted to early empirical treatment of the severely ill and vulnerable patients with an underlying health problem.