Shigellosis Treatment & Management

Updated: Aug 20, 2021
  • Author: Heba Rashid Ashraf, MD; Chief Editor: BS Anand, MD  more...
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Treatment

Approach Considerations

Maintain hydration in patients with shigellosis to compensate for fluid losses from diarrhea.

Antibiotic treatment is indicated in most patients with a positive stool culture for Shigella. Treatment can reduce symptoms by 2 days.

Indications for treatment per Centers for Disease Control and Prevention (CDC) recommendations include persons who work in public setting (ie, food handlers, childcare providers, residents of nursing homes), have a immunocompromised state (including individuals with human immunodeficiency virus [HIV] infection), and patients with severe disease (those who require hospitalization or have complications). Patients infected with Shigella may shed the bacteria for up to 6 weeks, even after resolution of symptoms. [3]

Avoid the use of antimotility agents, because they have the potential to worsen the symptoms and may predispose to toxic dilatation of the colon.

Clear liquids followed by a low residue, lactose-free diet are recommended until symptoms of shigellosis resolve.

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Medical Care

General supportive care of patients with shigellosis includes the following [42] :

  • Treat high fever in children.

  • Avoid narcotic-related antidiarrheals.

  • Antibiotic treatment is indicated in most patients. [43] Note that antibiotic-resistant Shigella species have emerged [19, 20] ; thus, obtaining susceptibility testing and monitoring local shigellosis outbreaks is crucial.

  • Clear liquids followed by a low-residue, lactose-free diet is recommended until symptoms of shigellosis resolve.

As noted earlier, antimotility agents should be avoided, as they have the potential to worsen symptoms and may predispose to toxic dilatation of the colon.

For fluid and electrolyte supplementation, oral rehydration solutions are preferable.

Consultations

Consult a gastroenterologist or an infectious diseases expert if the Shigella infection is prolonged or if the patient experiences a severe course of shigellosis that is unresponsive to antibiotics.

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Prevention

A vaccine for shigellosis is not currently available. Until a vaccine is available, the following measures can help prevent the dissemination of shigellosis:

  • Use of safe drinking water

  • Chlorination of unreliable water sources

  • Strict handwashing

  • Refrigeration and proper preparation and cooking of food. Food handlers must be treated with antibiotics and should not be involved in food preparation as long as stool cultures are positive for Shigella infection. At least 48 hours of antibiotic treatment are usually required.

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