Table 1. 2005 WHO guidelines: antimicrobials for treatment of shigellosis (adapted) [4].

Antimicrobial	Treatment schedule for children	Limitations
1st-line: ciprofloxacin	15 mg/kg orally twice daily for 3 days	Expensive
		Resistance emerging
		Drug interactions
2nd-line: pivmecillinam	20 mg/kg orally 4 times daily for 5 days	Cost
		No paediatric formulation
		Four times daily dosing
		Resistance emerging
OR*: ceftriaxone	50–100 mg/kg intramuscular injection for 2–5 days	Requires parenteral administration
		Generates antimicrobial resistance
OR: (for adults) azithromycin	6–20 mg/kg, orally once daily for 1–5 days	Cost
		Drug interactions
		Resistance emerges rapidly, spreads to other bacteria

^*Ceftriaxone is listed as an alternative therapy ‘only for use when local strains of shigella are known to be resistant to ciprofloxacin’.