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 cornerstones of the treatment of Shigellosis are fluid and salt replacement and antibiotic therapy. For the majority of patients, oral fluid replacement is adequate and should consist of

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 with 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).

• 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.

• 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.

• Fever should be treated with antipyretics, particularly among pediatric patients, as Shigella gastroenteritis can be associated with prolonged high grade fevers.

Antibiotic Therapy

• Antibiotic therapy is always indicated in patients with Shigella, as it has been demonstrated to decrease bacterial shedding and shorten the duration of infection.

• Antibiotic therapy should be considered even among asymptomatic patients with positive Shigella testing.

• Drug-resistant Shigella has been widely reported, and all patients with documented Shigella infections should have an antibiogram performed to identify the appropriate antimicrobial agent to use.

• Recommended regimens are summarized below.

Antibiotic Agents for the Treatment of Shigellosis

Agent	Recommended Dose	Duration
Trimethoprim/Sulfamethoxazole (TMP/SMX)	160/800 mg PO twice daily Some strains are resistant (Check antibiogram)	3 days (One week for immunocompromised patients)
Norfloxacin	400 mg PO twice daily Do not use in cases of bacteremia	3 days (One week for immunocompromised patients)
Ciprofloxacin	500 mg PO twice daily	3 days (One week for immunocompromised patients)

References

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