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Therapy for shigellosis
168
Editorial correspondence
REFERENCES
The Journal of Pediatrics July 1989
Therapy for shi.qellosis
1. Pryor JA, Webber BA, Hodson ME, Batten JC. Evaluation of the forced expiration technique as an adjunct to postural drainage in treatment of cystic fibrosis. Br Med J 1979; 2:417-8. 2. Webber BA. The Brompton Hospital guide to chest physiotherapy. 5th ed. Oxford: Blackwell Scientific, 1988. 3. Sutton PP, Parker RA, Webber BA. Assessment of the forced expiration technique, postural drainage and directed coughing in chest physiotherapy. Eur J Respir Dis 1983; 64:62-8. 4. Webber BA, Parker RA, Hofmeyr JL, Hodson ME. Evaluation of self-percussion during postural drainage using the forced expiration technique. Physiotherapy Practice 1985; 1:42-5. 5. Webber BA, Hofmeyr JL, Morgan MDL, Hodson ME. Effects of postural drainage incorporating the forced expiration technique on pulmonary function in cystic fibrosis. Br J Dis Chest 1986;80:353-9.
Reply To the Editor." w e regret the dismay we have caused Miss Webber and Miss Pryor, and we acknowledge the great pioneering work done in the Brompton Hospital in the field of physiotherapy. However, the purpose of all forms of physiotherapy, including both conventional physiotherapy with percussion and postural drainage and the forced expiration technique, is to help mobilize respiratory tract secretions and facilitate expectoration by stimulating cough. The line in our article after the material quoted in the above letter reads: "A minimum of three coughs was performed, or coughs were performed until there was no more sputum to expectorate." Our series of expiratory maneuvers was described in the Methods section because it does differ from the Brompton technique. Our study was undertaken because conventional chest physiotherapy imposes tremendous time and emotional costs on patients with cystic fibrosis. We were determined to see whether we could find an alternative to percussion and postural drainage. The forced expiration technique described is simple to learn and has been found to be very effective by many of our patients. Nowhere in the article did we state that the Brompton physiotherpists used their forced expiration technique without conventional physiotherapy, but forced expiratory maneuvers are an alternate method that we believe deserve comparison with conventional physiotherapy. The Brompton physiotherapists object to our techniques as described, but there are those who believe that forced prolonged expiratory maneuvers of any kind can lead to airway compression and bronchoconstriction (e.g., Oberwaldner et al., Pediatr Pulmonol 1986;2:358-67. We have strived to simplify our patients' lives by trying to determine whether conventional physiotherapy does lessen the progressive pulmonary decline characteristic of cystic fibrosis. Our long-term study demonstrates a strong suggestion that pulmonary disease progresses more rapidly when percussion and postural drainage are discontinued.
J. J. Reisman, MD H. Levison, MD The Hospital for Sick Children Toronto, Ontario M5G IX8, Canada
To the Editor: Salam and Bennish (J PEDIATR1988; 113:901-7) concluded that nalidixic acid is an effective alternative to ampicillin in the treatment of shigellosis. We want to call attentiofi to the problem of antibiotic resistance. The more antibiotics are used, the more resistance will develop. We have studied drug resistance in Shigella strains prospectively in a rural area near Ankara (S. flexneri, 21 cases; S. sonnei, 8 cases; S. boydii, l case)? Comparison with data from a study in the same region in 19812 shows that the resistance to shigellae has increased:
Agent Sulfamethoxazole-trimethoprim Ampicillin Nalidixic acid
Resistant species (%) 1981 1988 7.5 53 30 43 1 23
We want to emphasize that the antibiotics should be used mainly in severe shigella dysentery (particularly due to S. dysenteriae). We must he careful using antibiotic treatment because of the danger of antibiotic resistance.
L Safa Kaya, MD Mehmet Ceyhan, MD I~gur Dilmen, MD Department of Pediatrics Turkish Health and Therapy Foundation Memorial Ahmet Ors Hospital 06510 Emek Ankara, Turkey Volkan Korten, MD Ali Mert, PhD Department of Internal Medicine and Public Health Laboratory Etimesgut Rural Hospital Ankara, Turkey REFERENCES 1.
Ceyhan M, Dilmen U, Korten V, Mert A. Shigella diarrhoea and treatment. Lancet 1988;2:45-6 Berkman E. The serotypes and antibiotic resistance of shigellae. (~ocuk Sa~l Hast Derg 1983;26:27%86.
Reply, To the Editor: Dr. Kaya and colleagues raise important points concerning which patients with shigellosis should receive antimicrobial therapy, and whether selective treatment of patients with shigellosis would slow the development of resistance to antimierobial agents used for its treatment. Our study, like most studies evaluating treatment of shigellosis, included only patients with shigellosis who had signs and symptoms of dysentery. Our finding that effective antimicrobial therapy leads to a statistically significant and clinically important reduction in the duration of dysentery and fever is consistent with
Editorial correspondence
REFERENCES
The Journal of Pediatrics July 1989
Therapy for shi.qellosis
1. Pryor JA, Webber BA, Hodson ME, Batten JC. Evaluation of the forced expiration technique as an adjunct to postural drainage in treatment of cystic fibrosis. Br Med J 1979; 2:417-8. 2. Webber BA. The Brompton Hospital guide to chest physiotherapy. 5th ed. Oxford: Blackwell Scientific, 1988. 3. Sutton PP, Parker RA, Webber BA. Assessment of the forced expiration technique, postural drainage and directed coughing in chest physiotherapy. Eur J Respir Dis 1983; 64:62-8. 4. Webber BA, Parker RA, Hofmeyr JL, Hodson ME. Evaluation of self-percussion during postural drainage using the forced expiration technique. Physiotherapy Practice 1985; 1:42-5. 5. Webber BA, Hofmeyr JL, Morgan MDL, Hodson ME. Effects of postural drainage incorporating the forced expiration technique on pulmonary function in cystic fibrosis. Br J Dis Chest 1986;80:353-9.
Reply To the Editor." w e regret the dismay we have caused Miss Webber and Miss Pryor, and we acknowledge the great pioneering work done in the Brompton Hospital in the field of physiotherapy. However, the purpose of all forms of physiotherapy, including both conventional physiotherapy with percussion and postural drainage and the forced expiration technique, is to help mobilize respiratory tract secretions and facilitate expectoration by stimulating cough. The line in our article after the material quoted in the above letter reads: "A minimum of three coughs was performed, or coughs were performed until there was no more sputum to expectorate." Our series of expiratory maneuvers was described in the Methods section because it does differ from the Brompton technique. Our study was undertaken because conventional chest physiotherapy imposes tremendous time and emotional costs on patients with cystic fibrosis. We were determined to see whether we could find an alternative to percussion and postural drainage. The forced expiration technique described is simple to learn and has been found to be very effective by many of our patients. Nowhere in the article did we state that the Brompton physiotherpists used their forced expiration technique without conventional physiotherapy, but forced expiratory maneuvers are an alternate method that we believe deserve comparison with conventional physiotherapy. The Brompton physiotherapists object to our techniques as described, but there are those who believe that forced prolonged expiratory maneuvers of any kind can lead to airway compression and bronchoconstriction (e.g., Oberwaldner et al., Pediatr Pulmonol 1986;2:358-67. We have strived to simplify our patients' lives by trying to determine whether conventional physiotherapy does lessen the progressive pulmonary decline characteristic of cystic fibrosis. Our long-term study demonstrates a strong suggestion that pulmonary disease progresses more rapidly when percussion and postural drainage are discontinued.
J. J. Reisman, MD H. Levison, MD The Hospital for Sick Children Toronto, Ontario M5G IX8, Canada
To the Editor: Salam and Bennish (J PEDIATR1988; 113:901-7) concluded that nalidixic acid is an effective alternative to ampicillin in the treatment of shigellosis. We want to call attentiofi to the problem of antibiotic resistance. The more antibiotics are used, the more resistance will develop. We have studied drug resistance in Shigella strains prospectively in a rural area near Ankara (S. flexneri, 21 cases; S. sonnei, 8 cases; S. boydii, l case)? Comparison with data from a study in the same region in 19812 shows that the resistance to shigellae has increased:
Agent Sulfamethoxazole-trimethoprim Ampicillin Nalidixic acid
Resistant species (%) 1981 1988 7.5 53 30 43 1 23
We want to emphasize that the antibiotics should be used mainly in severe shigella dysentery (particularly due to S. dysenteriae). We must he careful using antibiotic treatment because of the danger of antibiotic resistance.
L Safa Kaya, MD Mehmet Ceyhan, MD I~gur Dilmen, MD Department of Pediatrics Turkish Health and Therapy Foundation Memorial Ahmet Ors Hospital 06510 Emek Ankara, Turkey Volkan Korten, MD Ali Mert, PhD Department of Internal Medicine and Public Health Laboratory Etimesgut Rural Hospital Ankara, Turkey REFERENCES 1.
Ceyhan M, Dilmen U, Korten V, Mert A. Shigella diarrhoea and treatment. Lancet 1988;2:45-6 Berkman E. The serotypes and antibiotic resistance of shigellae. (~ocuk Sa~l Hast Derg 1983;26:27%86.
Reply, To the Editor: Dr. Kaya and colleagues raise important points concerning which patients with shigellosis should receive antimicrobial therapy, and whether selective treatment of patients with shigellosis would slow the development of resistance to antimierobial agents used for its treatment. Our study, like most studies evaluating treatment of shigellosis, included only patients with shigellosis who had signs and symptoms of dysentery. Our finding that effective antimicrobial therapy leads to a statistically significant and clinically important reduction in the duration of dysentery and fever is consistent with