A federal program that monitors drug-resistant organisms is identifying Shigella bacteria with decreased susceptibility to azithromycin, particularly among men who have sex with men.

Antibiotic treatment is recommended for patients with severe symptoms, bloody diarrhea, or a compromised immune system, but Shigella bacteria often are resistant to the traditional first-line antibiotics such as ampicillin and trimethoprim-sulfamethoxazole. Azithromycin, the most commonly used antibiotic in the United States, is recommended for children and adults with multidrug-resistant Shigella infections. The problem, however, is that no clinical laboratory guidelines exist to guide testing isolates for susceptibility to azithromycin.

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