Shigellosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Serge Korjian; Yazan Daaboul
Overview
The mainstay of therapy for Shigellosis are fluid and salt replacement and antibiotic therapy. For the majority of patients, oral fluid replacement is adequate. IV fluids should be reserved for patients with severe disease who cannot tolerate oral therapy. Antimicrobial therapies for Shigellosis include either Ciprofloxacin, Pivmecillinam, or Azithromycin.
Medical Therapy
Fluid Replacement
- As with any infectious diarrhea, the most important initial step in the management of patients with shigellosis is fluid and salt replacement.
- Oral fluid replacement is sufficient for the majority of patients and can be accomplished by oral glucose or starch-containing electrolyte solutions. Oral rehydration solutions should contain the WHO-recommended electrolyte concentrations (Na 90 mM, K 20 mM, Cl 80 mM, HCO3 30 mM, and glucose 111 mM).[1]
- Oral fluid replacement is superior to IV fluids for patients who can tolerate it.
- Oral rehydration solutions can be prepared by mixing 3.5 g of NaCl, 2.5 g of NaHCO3 (or 2.9 g of Na citrate), 1.5 g of KCl, and 20 g of glucose or glucose polymer (e.g., 40 g of sucrose or 4 tablespoons of sugar or 50–60 g of cooked cereal flour such as rice, maize, sorghum, millet, wheat, or potato) per liter of clean water.[1]
- IV fluid replacement should be tailored to the individual patient's lab findings (electrolytes, BUN, creatinine).
Symptomatic Treatment
- Antimotility agents (such as diphenoxylate or loperamide) are not recommended for patients with documented Shigella infections. These agents may prolong the infection and increase the shedding of Shigella organisms.[2]
- Fever should be treated with antipyretics, particularly among pediatric patients, as shigellosis can be associated with prolonged high grade fevers and febrile seizures.
Antimicrobial Regimen
- 1. Shigellosis [3]
- 1.1 Adults
- Preferred regimen (1): Ciprofloxacin 500 mg PO bid for 3 days
- Alternative regimen (1): Pivmecillinam 100 mg PO qid for 5 days
- Alternative regimen (2): Azithromycin 1-1.5 g PO qd for 1 to 5 days
- 1.2 Pediatrics
- Preferred regimen (1): Ciprofloxacin 15 mg/kg PO bid for 3 days
- Alternative regimen (1): Pivmecillinam 20 mg/kg PO qid for 5 days
- Alternative regimen (2): Ceftriaxone 50-100 mg/kg IM qd for 2 to 5 days
- Alternative regimen (3): Azithromycin 6-20 mg/kg PO qd for 1 to 5 days
References
- ↑ 1.0 1.1 Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV; et al. (2001). "Practice guidelines for the management of infectious diarrhea". Clin Infect Dis. 32 (3): 331–51. doi:10.1086/318514. PMID 11170940.
- ↑ Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.
- ↑ "Guidelines for the control of shigellosis, including epidemics due to Shigella dysenteriae type 1" (PDF).