Treatment of dysentery

In severe and moderate cases of dysentery, bed rest is indicated, in mild cases - ward regimen. In the acute period with significant intestinal disorders, treatment of dysentery should be combined with diet No. 4 according to Pevzner. With improvement of the condition, reduction of intestinal dysfunction and appearance of appetite, patients are transferred to table No. 2 or No. 13, and 2-3 days before discharge from the hospital - to the general table No. 15.

Etiotropic treatment of dysentery

• When prescribing antibacterial treatment for dysentery to a patient, it is necessary to take into account information about the territorial landscape of drug resistance, i.e. about the sensitivity of Shigella strains isolated from patients in a given area recently.
• The duration of the etiotropic therapy course is determined by the improvement of the patient's condition. In case of moderate infection, the etiotropic therapy course is limited to 3-4 days, in case of severe infection - 5-6 days.
• Combinations of two or more antibiotics (chemotherapy drugs) should be strictly limited to severe cases of the disease.
• In the case of the gastroenteric variant of shigellosis, etiotropic treatment is not indicated.

Patients with a mild form of shigellosis at the height of the disease are prescribed furazolidone in a dose of 0.1 g four times a day. In case of moderate shigellosis, drugs of the fluoroquinolone group are prescribed: ofloxacin in a dose of 0.2-0.4 g twice a day or ciprofloxacin in a dose of 0.25-0.5 g twice a day; in case of a severe course - ofloxacin in a dose of 0.4 g twice a day or ciprofloxacin 0.5 g twice a day: fluoroquinolones in combination with second-generation cephalosporins (cefuroxime in a dose of 1 g three times a day) or third-generation (ceftazidime or cefoperazone 1 g three times a day). In the first 2-3 days of treatment, the drugs are administered parenterally, then they are switched to oral administration.

Treatment of Grigoriev-Shiga dysentery is based on the administration of ampicillin and nalidixic acid. Ampicillin is administered intramuscularly at a daily dose of 100-150 mg/kg every 4-6 hours for 5-7 days. Nalidixic acid is prescribed at a dose of 1 g four times a day for 5-7 days.

In shigellosis Flexner and Sonne, a polyvalent dysentery bacteriophage is effective. The drug is available in liquid form and in tablets with an acid-resistant coating. It is taken orally 1 hour before meals in a dose of 30-40 ml three times a day or 2-3 tablets three times a day. Rectal administration of liquid bacteriophage is possible. In severe cases, the drug is not indicated due to the risk of massive lysis of shigella and aggravation of intoxication.

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Pathogenetic treatment of dysentery

• Rehydration treatment of dysentery is carried out. In mild cases, oral administration of solutions of Oralit, Regidron, and Cycloglucosolan is used. The rate of administration of solutions is 1-1.5 l/h. In moderate and severe cases, intravenous administration of crystalloid solutions of Chlosol, Quartasol, and Trisol is used, taking into account the degree of dehydration and the patient's body weight at a rate of 60-100 ml/min or higher.
• In the absence of severe dehydration and signs of intoxication, a 5% glucose solution and plasma substitutes (hemodez, rheopolyglucin) are used. In the gastroenteric variant of acute shigellosis, medical care should begin with gastric lavage with water or 0.5% sodium bicarbonate solution, using a gastric tube for this purpose.
• To bind and remove the toxin from the intestines, one of the enterosorbents is prescribed: polyphepan, one tablespoon three times a day, activated carbon at a dose of 15-20 g three times a day, enterodesis, 5 g three times a day, polysorb MP, 3 g three times a day, smecta, one packet three times a day.
• Intestinal antiseptics: oxyquinoline (one tablet three times a day), enterol - an antidiarrheal drug of biological origin (from the yeast Saccharomyces boulardii) is prescribed 1-2 capsules twice a day.
• To correct and compensate for digestive insufficiency, enzyme preparations are used: acidin-pepsin, pancreatin, panzinorm in combination with calcium preparations (at a dose of 0.5 g twice a day).
• In the acute period, to relieve colon spasm, drotaverine hydrochloride (no-shpa) is prescribed at 0.04 g three times a day, belladonna preparations (bellastezin, besalol).
• During the entire treatment period, a vitamin complex is recommended, consisting of ascorbic acid (500-600 mg/day), nicotinic acid (60 mg/day), thiamine and riboflavin (9 mg/day).
• In order to correct the intestinal biocenosis, patients with severe colitic syndrome are prescribed drugs based on microorganisms of the genus Bacillus upon admission: biosporin, baktisporin, two doses twice a day for 5-7 days. When choosing a drug, preference should be given to modern complex drugs: probifor, linex, bifidumbacterin-forte, florin forte, etc.

Approximate periods of incapacity for work

In mild cases - 7-10 days, in moderate cases - up to 16-18 days, in severe cases and complications - up to a month or more. Patients from the decreed group are not allowed to work until they receive two negative results of bacteriological examination of feces.

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Outpatient observation

Patients with chronic dysentery, food industry workers and persons equivalent to them are subject to dispensary observation (for 3 months, and for 6 months in the case of chronic dysentery).

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Patient information sheet

Shigellosis (dysentery) is an infectious disease transmitted by food, water or contact-household means. To prevent it, it is necessary to observe sanitary and hygienic standards, refrain from eating poor-quality food and raw water. Shigellosis is characterized by a rise in temperature, malaise, loose stools, often with an admixture of mucus and blood, abdominal pain. If these symptoms appear, you must immediately consult a doctor and begin treatment for dysentery. Stopping treatment and returning to work is possible after the condition has normalized and a negative bacteriological analysis of feces has been obtained, and for workers in the food industry, public catering and water supply enterprises, and children's institutions - two negative results of bacteriological tests.