Shigellosis cases open up a new AMR challenge in Keralam

Antimicrobial resistance (AMR) is emerging as a new challenge in Keralam, with clinicians expressing concern over the increasing resistance profile of primary antibiotics used to treat primary infections like Shigellosis. According to KARS-NET, which has been tracking the AMR profile of Shigellosis since 2023, ciprofloxacin, an important treatment option for bacterial dysentery, shows a resistance profile of 96%, rendering it less effective for empirical treatment of Shigellosis.

Moreover, resistance to the next available drug, ceftriaxone, a third-generation cephalosporin class antibiotic, has also increased to 36%. R. Aravind, head of infectious diseases at Government Medical College, Thiruvananthapuram and convener of KARS-Net, warns that the shrinking arsenal of effective and affordable antibiotics for common infections in the community is a cause for alarm.

Most acute diarrhoeal diseases are self-limiting, but Shigellosis, particularly in vulnerable populations, can lead to severe dehydration, sepsis and neurological complications, necessitating the use of antibiotics. The growing resistance of Shigella to third-generation cephalosporins like ceftriaxone makes it crucial to administer the correct antibiotic within an hour for patients with severe dysentery, as high-end drugs like carbapenem, considered last-resort antibiotics, may be required for critical cases.

The State experienced one of the major outbreaks of Shigellosis in June, with 225 cases and six deaths reported from Kozhikode, Malappuram, and Wayanad districts. Even though it is unclear if AMR contributed to the fatalities, the high fatality rate alongside the rising AMR profile of Shigellosis should be a cause for concern.