Table 5. Common adverse reactions to antibiotics currently indicated to treat shigellosis in children [7,33].

Antibiotic	Life-threatening	Mild adverse effects which may result in discontinuation of treatment	Other	Relevant interactions
Fluoroquinolones:CiprofloxacinNorfloxacinOfloxacin	Hypersensitivity reactions;	Dyspepsia, headache, diarrhoea, vomiting, hypotension	Tendonitis and tendon rupture; peripheral neuropathy.	All fluoroquinolones should be used with caution in patients receiving drugs known to prolong the QT interval
	Prolonged QT syndrome			The toxicity of fluoroquinolones is increased by the concurrent use of systemic steroidal medications
			A 2010 systematic review of ciprofloxacin safety in paediatrics concluded that although musculoskeletal adverse effects occur owing to ciprofloxacin use, these events are reversible [14]
				Fluoroquinolones’ effects are reduced by the co-administration of iron- and zinc-containing products, of importance when zinc-containing products are used to treat diarrhoea in children.
				Fluoroquinolones cause additive toxicity with non-steroidal anti-inflammatory drugs (ibuprofen, meloxicam, naproxen)
Azithromycin	Hypersensitivity reactions;	Dyspepsia, flatulence, headache, disturbance in taste, anorexia	Malaise, paraesthesia	Macrolides use not advised with other drugs which prolong the QT interval, (including anti-malarial medications such as artemether-lumefantrine) owing to the risk of ventricular arrhythmias. However, azithromycin has been identified as a safer macrolide (in terms of its ability to prolong the QT interval) in this class of antibiotics.
	Prolonged QT syndrome
				Plasma concentrations of azithromycin are increased by ritonavir
				Azithromycin in combination with rifabutin results in increased side-effects of rifabutin, including neutropenia
Ceftriaxone	Hypersensitivity reactions	Diarrhoea, headache, abdominal discomfort	Transient cholestatic jaundice owing to biliary sludge formation	Relevant interactions for all cephalosporins:
				Increased risk of nephrotoxicity when co-administered with aminoglycosides
				Enhance anticoagulant effect of coumarins
Cefixime	Hypersensitivity reactions; immune-mediated haemolytic anaemia	Flatulence, headache, abdominal pain, defaecation urgency, nausea, constipation, vomiting	Transient cholestatic jaundice owing to biliary sludge formation	As per ceftriaxone
Pivmecillinam	As with all penicillins: hypersensitivity reactions, serum-sickness-like reactions, anaphylaxis	Diarrhoea, joint pain, rashes, urticaria	Avoid use in acute porphyrias	Contra-indicated for concurrent use with sodium valproate