Clinical features: Bacillary dysentery is caused by bacilli belonging to the Shigella genus with three main pathogenic groups, namely S. dysenteriae, S. flexneri and S. Sonnei. In Tanzania the most common bacillus is S. Flexineri. However S. dysenteries tends to cause epidemics. The main clinical features of bacillary dysentery are diarrhoea, colicky abdominal pain and tenesmus. The diarrhoea, contain blood and purulent exudate with little fecal matter. Fever, dehydration and weakness occur particularly if diarrhoea persists. While the above clinical features are indicative of bacillary dysentery specific diagnosis depends on culture of faeces. Antibiotics are only indicated if the patient is very ill with fever.
Management
Rehydration is important if diarrhoea persist and the patient is dehydrated.
Treatment guidelines
Antibiotics are not usually needed. Give only in severe cases in a toxic, febrile patients.
For shigella |
|
Drug of choice |
Co-trimoxazole (O) |
Adult |
960 mg 12 hourly for 5 days. |
Children 6 weeks - 5 months |
120 mg every 12 hours for 5 days. |
6 month - 5 years |
240 mg every 12 hours for 5 days. |
6 - 12 years |
480 mg every 12 hours for 5 days. |
Second choice |
Amoxycillin (O) |
Adult |
250 mg eight hourly for 5 days. |
Children Up to 10 years |
125 mg eight hourly for 5 days. |
For Yersinia |
|
Drug of choice |
Doxycycline (O) |
Adult only |
200 mg initially then 100 mg once daily for 5 days. |
NOTE: Double the dose in severe infection. 200 mg twice daily for 5 days. |
For Campylobacter |
|
Drug of choice |
Erythromycin (O) |
Adult and Children over 8 years |
250 - 500 mg 6 hourly for 5 days. |
Children |
10 mg/kg body weight six hourly for 5 days. |
Up to |
2 years |
125 mg 6 hourly for 5 days. |
| |
2 - 8 years |
250 mg 6 hourly for 5 days. |
