Studies of the Acute Diarrheal Diseases: X D. Further Studies on the Relative Efficacy of Sulfonamides in Shigellosis

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Abstract
Sulfonamides were used in treating a series of 333 hospitalized cases of acute diarrhea which were culturally positive for Shigellae (Flexner or Sonne). There was a prompt clinical and bacteriological response to sulfadiazine, sulfapyrazine and sulfamethazine in all but 2-3% of Flexner cases and 15 to 20% of Sonne cases. There were 6 deaths. There were complicating conditions in 4 of these cases. One child died with a toxic nephritis presumably induced by the sulfonamide (sulfamethazine). One fulminating infection due to Shigella sonnei terminated fatally; the organism isolated was found highly resistant to sulfonamides. Considering all 6 fatalities as failures of sulfonamide therapy, the case fatality rate was 1.8%. In a series of 424 cases observed in New Mexico and Georgia before sulfonamides were used in shigellosis the fatality rate was 8.7%. There were few and minor toxic reactions when sulfadiazine or sulfapyrazine were used; severe toxic reactions were unduly frequent when sulfamethazine was used. Both sulfadiazine and sulfapyrazine are considered highly satisfactory in the treatment of acute shigellosis.