Shigellosis medical therapy
|
Shigellosis Microchapters |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Shigellosis medical therapy On the Web |
|
American Roentgen Ray Society Images of Shigellosis medical therapy |
|
Risk calculators and risk factors for Shigellosis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Serge Korjian; Yazan Daaboul
Overview
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.
References
| 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) |