Dysentery medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

Dysentery is initially managed by maintaining fluid intake using oral rehydration therapy. If this treatment cannot be adequately maintained due to vomiting or the profuseness of diarrhea, hospital admission may be required for intravenous fluid replacement. In ideal situations, no antimicrobial therapy should be administered until microbiological microscopy and culture studies have established the specific infection involved. When laboratory services are not available, it may be necessary to administer a combination of drugs, including an amoebicidal drug to kill the parasite and an antibiotic to treat any associated bacterial infection.

If shigella is suspected and it is not too severe, the doctor may recommend letting it run its course — usually less than a week. The patient will be advised to replace fluids lost from diarrhea. If the shigella is severe, the doctor may prescribe antibiotics, such as ciprofloxacin or TMP-SMX (Bactrim). However, many strains of shigella are becoming resistant to common antibiotics, and effective medications are often in short supply in developing countries. If necessary, a doctor may have to reserve antibiotics for those at highest risk for death, including young children, people over 50, and anyone suffering from dehydration or malnutrition.

Amoebic dysentery usually calls for a two-pronged attack. Treatment should start with a 10-day course of the antimicrobial drug metronidazole (Flagyl). To finish off the parasite, the doctor can prescribe a course of diloxanide furoate (available only through the Centers for Disease Control and Prevention), paromomycin (Humatin), or iodoquinol (Yodoxin).

Shown below is a table summarizing the preferred and alternative empiric treatment for Dysentery.

Characteristics of the Patient	Possible Pathogens	Preferred Treatment	Duration of Treatment
Immunocompetent patient	Shigella species	TMP-SMZ, 160 and 800 mg, respectively (pediatric dose, 5 and 25 mg/kg, respectively) b.i.d. (if susceptible) OR Fuoroquinolone(e.g., 300 mg ofloxacin, 400 mg norfloxacin, or 500 mg ciprofloxacin b.i.d.) (A-I); nalidixic acid, 55 mg/kg/d (pediatric) or 1 g/d (adults) OR Ceftriaxone OR Azithromycin	TMP-SMZ for 3 days OR Flouroquinolones[( ofloxacin,norfloxacin and ciprofloxacin for 3 days ) and (nalidixic acid for 5 days )]
Immunocompromised patient	Shigella species	Same as above	Same as above except that duration of antibiotics is for 7- 10 days
Immunocompetent patient	Non-typhi species of Salmonella	Not recommended routinely, but if severe or patient is <6 mo or >50 y old or has prostheses, valvular heart disease, severe atherosclerosis, malignancy, or uremia, TMP-SMZ (if susceptible) or fluoroquinoloneas above, b.i.d; OR ceftriaxone, 100 mg/kg/d in 1 or 2 divided doses	TMP-SMZ (if susceptible) or fluoroquinolone for 5 - 7 days
Immunocompromised patient	Non-typhi species of Salmonella	Same as above	Same as above except that duration of antibiotics is for 14 days (or longer if relapsing)