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

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.

• Recommended regimens are summarized below.

References

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