Dysentery, bacillary

A02.0/A03.0/A04.5

DESCRIPTION

Acute infection of the bowel usually caused by Shigella, Salmonella or Campylobacter.

There is sudden onset diarrhoea with:

  • blood (not due to haemorrhoids or anal fissure) or mucous in the stools
  • convulsions (in children)
  • fever
  • tenesmus

GENERAL MEASURES

  • Prevent spread of micro-organism by:
    • good sanitation to prevent contamination of food and water
    • washing hands thoroughly before handling food
    • washing soiled garments and bed clothes

MEDICINE TREATMENT

Treat dehydration vigorously.

Children
Treat dehydration according to: Diarrhoea, acute in children.

Adults
Oral treatment:

  • Oral rehydration solution (ORS).

OR
Homemade sugar and salt solution.

Homemade sugar and salt solution (SSS)
½ level medicine measure of table salt
plus
8 level medicine measures of sugar
dissolved in 1 litre of boiled (if possible) then cooled water
(1 level medicine measure = approximately 1 level 5 mL teaspoon)

Oral rehydration volume will depend on the severity of the dehydration.

IV treatment:

  • Sodium chloride, 0.9%, IV.

AND

Antibiotic therapy

Indicated for:

  • Children > 1 year of age and adults with blood in the stools.
  • HIV-infected patients.
  • Children < 12 months of age.

Children

Children < 12 months of age

  • Ceftriaxone, IM, 80 mg/kg/dose immediately as a single dose and refer. See paediatric dosing tool.
    • Do not inject more than 1 g at one injection site.

CAUTION: USE OF CEFTRIAXONE IN NEONATES AND CHILDREN

  • If SUSPECTING SERIOUS BACTERIAL INFECTION in neonate, give ceftriaxone, even if jaundiced.
  • Avoid giving calcium-containing IV fluids (e.g. Ringer Lactate) together with ceftriaxone:
    • If ≤ 28 days old, avoid calcium-containing IV fluids for 48 hours after ceftriaxone administered.
    • If > 28 days old, ceftriaxone and calcium-containing IV fluids may be given sequentially provided the giving set is flushed thoroughly with sodium chloride 0.9% before and after.
    • Preferably administer IV fluids without calcium contents.
  • Always include the dose and route of administration of ceftriaxone in the referral letter.

Adults

  • Ciprofloxacin, oral, 500 mg 12 hourly for 3 days.

Note:

  • Check for complications such as intestinal perforation or peritonitis.
  • Ensure adequate urine output to exclude haemolytic uraemic syndrome.

REFERRAL

  • Severe illness.
  • Persistent blood in urine on dipstix or macroscopically.
  • Acute abdominal signs (severe pain, acute tenderness, persistent or bilious vomiting).
  • Bloody mucous passed in absence of diarrhoea.
  • Failure to respond within 3 days.
  • Malnutrition in children.
  • Dehydration in children.
  • Children < 12 months of age.