{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:59:29Z","timestamp":1790816369434,"version":"4.1.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract\u2003<\/jats:title>\n                  <jats:p>Shigellosis remains highly relevant to military medicine because acute diarrheal illness during travel and deployment can impair operational readiness, reduce physical performance, and increase lost duty days. At the same time, oral treatment options are increasingly constrained by antimicrobial resistance, intolerance, contraindications, and occasional supply limitations in operational or austere settings. We report 3 adults with microbiologically documented shigellosis treated with oral pivmecillinam at our institution and summarize the limited published in vivo clinical evidence. In all 3 cases, pivmecillinam was used as a susceptibility-guided oral strategy when standard oral options were restricted. Clinical improvement occurred within 48 hours in each patient, and no immediate treatment escalation was required. Published evidence consists mainly of small, older randomized trials, most of them conducted in children, suggesting clinical activity of pivmecillinam against historical comparators, although 1 pediatric trial found ciprofloxacin to be bacteriologically superior. These findings suggest that pivmecillinam may represent a pragmatic oral alternative in selected cases of shigellosis when usual oral agents cannot be used. In military and other operational settings, its potential value lies in preserving an oral treatment pathway and reducing reliance on parenteral therapy. Contemporary comparative studies, especially in adults and in the context of current resistance patterns, are needed to better define its role.<\/jats:p>","DOI":"10.1093\/milmed\/usag451","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:12:53Z","timestamp":1789672373000},"source":"Crossref","is-referenced-by-count":0,"title":["Pivmecillinam for Shigellosis With Limited Oral Therapeutic Alternatives: A 3-Case Series and Narrative Review of Published In Vivo Clinical Evidence"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9821-6501","authenticated-orcid":false,"given":"Pierre-Louis","family":"Conan","sequence":"first","affiliation":[{"name":"Service de Maladies Infectieuses et Tropicales, H\u00f4pital National d\u2019Instruction des Arm\u00e9es B\u00e9gin , Saint-Mand\u00e9, 94160,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"France","family":"Charton","sequence":"additional","affiliation":[{"name":"Service de Pneumologie, H\u00f4pital National d\u2019Instruction des Arm\u00e9es Percy , Clamart, 92140,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinaherisoa","family":"Andriamanantena","sequence":"additional","affiliation":[{"name":"Service de Maladies Infectieuses et Tropicales, H\u00f4pital National d\u2019Instruction des Arm\u00e9es B\u00e9gin , Saint-Mand\u00e9, 94160,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9cile","family":"Ficko","sequence":"additional","affiliation":[{"name":"Service de Maladies Infectieuses et Tropicales, H\u00f4pital National d\u2019Instruction des Arm\u00e9es Laveran , Marseille, 13013,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurore","family":"Bousquet","sequence":"additional","affiliation":[{"name":"Service de Microbiologie, H\u00f4pital National d\u2019Instruction des Arm\u00e9es B\u00e9gin , Saint-Mand\u00e9, 94160,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"2026093019575824800_usag451-B1","doi-asserted-by":"publisher","first-page":"944","DOI":"10.4269\/ajtmh.2010.10-0190","article-title":"Gastrointestinal illnesses among French forces deployed to Djibouti: French military health surveillance, 2005-2009","volume":"83","author":"Ollivier","year":"2010","journal-title":"Am J Trop Med Hyg"},{"key":"2026093019575824800_usag451-B2","doi-asserted-by":"publisher","first-page":"19","DOI":"10.3201\/eid3014.240308","article-title":"Etiology and epidemiology of travelers\u2019 diarrhea among US military and adult travelers, 2018-2023","volume":"30","author":"Anderson","year":"2024","journal-title":"Emerg Infect Dis"},{"key":"2026093019575824800_usag451-B3","doi-asserted-by":"publisher","first-page":"34","DOI":"10.7205\/MILMED-D-17-00077","article-title":"Management of acute diarrheal illness during deployment: a deployment health guideline and expert panel report","volume":"182","author":"Riddle","year":"2017","journal-title":"Mil Med"},{"key":"2026093019575824800_usag451-B4","volume-title":"Guidelines for the Control of Shigellosis, Including Epidemics Due to Shigella Dysenteriae Type 1","author":"World Health Organization. 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Cefixime is ineffective in shigellosis in adults","volume":"123","author":"Salam","year":"1995","journal-title":"Ann Intern Med"},{"key":"2026093019575824800_usag451-B13","doi-asserted-by":"publisher","first-page":"99","DOI":"10.3109\/00365548409068414","article-title":"A comparison of the combination pivmecillinam\/pivampicillin and co-trimoxazole in the treatment of convalescent carriers of Salmonella and shigella","volume":"16","author":"Ekwall","year":"1984","journal-title":"Scand J Infect Dis"},{"key":"2026093019575824800_usag451-B14","doi-asserted-by":"publisher","first-page":"623","DOI":"10.3109\/00365549009027108","article-title":"Pivampicillin\/pivmecillinam in the treatment of shigella carriers","volume":"22","author":"Ekwall","year":"1990","journal-title":"Scand J Infect Dis"},{"key":"2026093019575824800_usag451-B15","doi-asserted-by":"publisher","first-page":"e0277574","DOI":"10.1371\/journal.pone.0277574","article-title":"Antimicrobial resistance in shigellosis: a surveillance study among urban and rural children over 20 years in Bangladesh","volume":"17","author":"Nuzhat","year":"2022","journal-title":"PLoS One"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag451\/71532611\/usag451.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag451\/71532611\/usag451.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:58:02Z","timestamp":1790812682000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag451\/8855752"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":15,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag451","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"usag451"}}