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gellosis
Shigellosis
– T here a re 4 s ero gro ups o f s higella : S. flexneri, S. boydii, S. sonnei a n d S.
dySsehnigtelrliaaed.ysenteriae type 1 (S d 1 ) is the o n ly s tra in tha t ca us es la rge s ca le epid em ics . O
the 4 s ero gro ups it ha s the highes t ca s e fa ta lity ra te (up to 1 0 % ).
– C ipro flo xa cin is curren tly the o n ly effective trea tm en t fo r s higello s is . I t is therefo re
es s en tia l to preven t the d evelo pm en t o f res is ta n ces .
Clinical features
B lo o d y d ia rrho ea w ith o r w itho ut fever, a b d o m in a l pa in a n d ten es m us , w hich is
o ften
in ten s e.
Pa tien ts w ith a t lea s t o n e o f the fo llo w in g criteria ha ve a n in crea s ed ris k o f d ea th:
– S ign s o f s erio us illn es s : • fever > 3 8 .5 °C
• m a ln utritio n (< 8 0 % o f the m ed ia n )
• s evere d ehyd ra tio n
• co n fus io n , s eizures o r co m a
– A ge gro ups a t ris k: • child ren un d er 5 yea rs
• a d ults o ver 5 0 yea rs
Treatment
– A n tib io tic trea tm en t: ceftriaxone
• ciprofloxacin PO is the firs t lin e trea tm en t
C hild ren : 3 0 m g/ kg/ d a y in 2 d ivid ed d o s es fo r 3 d a ys
A d ults : 1 g/ d a y in 2 d ivid ed d o s es fo r 3 d a ys
• in pregn a n t w o m en , cipro flo xa cin is co n tra -in d ica ted in prin ciple, us e
IM : 1 g o n ce d a ily fo r 3 to 5 d a ys
A m o xicillin is in effective in vivo . T he us e o f n a lid ixic a cid fa vo urs the d evelo pm en t
o f cipro bfluotyxlabrcoimnidreesPOis ta n ce.
hyoscine
– F o r pa in :
C hild ren fro m 6 to 1 2 yea rs : 1 0 m g, to b e repea ted every 8 ho urs if n eces s a ry
A d ults : 1 0 to 2 0 m g, to b e repea ted every 8 ho urs if n eces s a ry
A ll o pio id a n a lges ics a re co n tra -in d ica ted a s they s lo w peris ta ls is .
– S uppo rtive thera py:
• n utritio n : a ll pa tien ts w ith d ys en tery s ho uld receive n utritio n a l s upplem en ts
2 5 0 0 kca l/ d a y d urin g ho s pita lis a tio n
1 0 0 0 kca l/ d a y a s o utpa tien ts
C hild ren a lrea d y in n utritio n a l cen tres s ho uld b e is o la ted .
• reh yd ra t io n : s ys t em a t ic a d m in is t ra t io n o f ORS ( fo llo w t h e W H O
pro t o co ls ,
pa ges 3 1 6 to 3 2 1 ).
Shigellosis
– T here a re 4 s ero gro ups o f s higella : S. flexneri, S. boydii, S. sonnei a n d S.
dySsehnigtelrliaaed.ysenteriae type 1 (S d 1 ) is the o n ly s tra in tha t ca us es la rge s ca le epid em ics . O
the 4 s ero gro ups it ha s the highes t ca s e fa ta lity ra te (up to 1 0 % ).
– C ipro flo xa cin is curren tly the o n ly effective trea tm en t fo r s higello s is . I t is therefo re
es s en tia l to preven t the d evelo pm en t o f res is ta n ces .
Clinical features
B lo o d y d ia rrho ea w ith o r w itho ut fever, a b d o m in a l pa in a n d ten es m us , w hich is
o ften
in ten s e.
Pa tien ts w ith a t lea s t o n e o f the fo llo w in g criteria ha ve a n in crea s ed ris k o f d ea th:
– S ign s o f s erio us illn es s : • fever > 3 8 .5 °C
• m a ln utritio n (< 8 0 % o f the m ed ia n )
• s evere d ehyd ra tio n
• co n fus io n , s eizures o r co m a
– A ge gro ups a t ris k: • child ren un d er 5 yea rs
• a d ults o ver 5 0 yea rs
Treatment
– A n tib io tic trea tm en t: ceftriaxone
• ciprofloxacin PO is the firs t lin e trea tm en t
C hild ren : 3 0 m g/ kg/ d a y in 2 d ivid ed d o s es fo r 3 d a ys
A d ults : 1 g/ d a y in 2 d ivid ed d o s es fo r 3 d a ys
• in pregn a n t w o m en , cipro flo xa cin is co n tra -in d ica ted in prin ciple, us e
IM : 1 g o n ce d a ily fo r 3 to 5 d a ys
A m o xicillin is in effective in vivo . T he us e o f n a lid ixic a cid fa vo urs the d evelo pm en t
o f cipro bfluotyxlabrcoimnidreesPOis ta n ce.
hyoscine
– F o r pa in :
C hild ren fro m 6 to 1 2 yea rs : 1 0 m g, to b e repea ted every 8 ho urs if n eces s a ry
A d ults : 1 0 to 2 0 m g, to b e repea ted every 8 ho urs if n eces s a ry
A ll o pio id a n a lges ics a re co n tra -in d ica ted a s they s lo w peris ta ls is .
– S uppo rtive thera py:
• n utritio n : a ll pa tien ts w ith d ys en tery s ho uld receive n utritio n a l s upplem en ts
2 5 0 0 kca l/ d a y d urin g ho s pita lis a tio n
1 0 0 0 kca l/ d a y a s o utpa tien ts
C hild ren a lrea d y in n utritio n a l cen tres s ho uld b e is o la ted .
• reh yd ra t io n : s ys t em a t ic a d m in is t ra t io n o f ORS ( fo llo w t h e W H O
pro t o co ls ,
pa ges 3 1 6 to 3 2 1 ).
