Treatment of dysentery
Last reviewed: 23.04.2024
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In severe and mildly dysentery, there is a bed, with a light - ward mode. In an acute period with significant intestinal disorders, dysentery treatment should be combined with Pevzner's No. 4 diet. When the condition improves, bowel dysfunction and appetite decrease, the patients are transferred to the table № 2 or № 13, and 2-3 days before discharge from the hospital - to the general table № 15.
Etiotropic treatment of dysentery
- It is necessary to prescribe to the patient antibacterial treatment of dysentery taking into account information about the territorial landscape of drug resistance, i.e. On the sensitivity to it of Shigella strains isolated from patients in this area recently.
- The duration of the course of etiotropic therapy is determined by the improvement of the patient's condition. With an average form of infection, the course of etiotropic therapy is limited to 3-4 days, with a heavy - 5-6 days.
- Combinations of two or more antibiotics (chemotherapy drugs) should be strictly limited to severe cases of the disease.
- In the gastroenteritis shigellosis, etiotropic treatment is not indicated.
Patients with an easy form of shigellosis in the midst of the disease are prescribed furazolidone in a dose of 0.1 g four times a day. For moderate shigellosis, preparations of the group of fluoroquinolones are prescribed: ofloxacin in a dose of 0.2-0.4 g twice daily or ciprofloxacin in a dose of 0.25-0.5 g twice daily; at a heavy current - ofloxacin in a dose of 0.4 g twice daily or ciprofloxacin 0.5 g twice daily: fluoroquinolones in combination with cephalosporins of the second generation (cefuroxime at a dose of 1 g three times per day) or III 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 switch to ingestion.
Treatment of Grigoriev-Shigi dysentery is based on the appointment of ampicillin and nalidixic acid. Ampicillin is administered intramuscularly in a daily dose of 100-150 mg / kg every 4-6 hours for 5-7 days. Nalidixic acid is prescribed in a dose of 1 g four times a day for 5-7 days.
In the shigellosis of Flexner and Sonne, a polyvalent dysentery bacteriophage is effective. The drug is released in liquid form and in tablets with an acid-resistant coating. Take 1 hour before meals inside at 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. With severe current the drug is not indicated because of the danger of massive lysis of shigella and heaviness of intoxication.
[Pathogenetic treatment of dysentery
- Conduct rehydration treatment of dysentery. In mild form - oral administration of solutions oralit, rehydron, cyclo-glucosalan. The rate of introduction of solutions is 1-1.5 l / h. With moderate and severe current, IV / IV crystalloid dentifrice, chrysol, quartrel, trisol are used, taking into account the degree of dehydration and weight of the patient at a rate of 60-100 ml / min and above.
- In the absence of pronounced dehydration and signs of intoxication, 5% glucose solution and plasma substitutes (hemodez, reopolyglucin) are used. In the case of gastroenteritis of acute shigellosis, medical assistance to the patient should be started by rinsing the stomach with water or with 0.5% sodium bicarbonate solution, using a gastric tube for this.
- To bind and remove toxin from the intestine, one of the enterosorbents is prescribed: a polyphepan one tablespoon three times a day, activated charcoal in a dose of 15-20 g three times a day, enterodesis 5 g three times a day, polysorb MP at 3 g three once a day, smect one packet three times a day.
- Intestinal antiseptics: oxyquinoline (one tablet three times a day), enterol - antidiarrhoeal drug of biological origin (from the yeast Saccharomyces boulardii) appoint 1-2 capsules twice a day.
- To correct and compensate for digestive failure, enzyme preparations are used: acid-pepsin, pancreatin, panzinorm in combination with calcium preparations (0.5 g twice daily).
- In the acute period for the relief of colonic spasm appoint drotaverina hydrochloride (no-shpa) to 0.04 g three times a day, preparations belladonna (bellestezin, besalol).
- During the whole treatment period, a vitamin complex is recommended, consisting of ascorbic (500-600 mg / day), nicotinic acid (60 mg / day), thiamine and riboflavin (9 mg / day).
- In order to correct the intestinal biocenosis, patients with a marked colitis syndrome on admission are prescribed drugs based on microorganisms of the genus Bacillus: biosporin, bactisporin, two doses twice a day for 5-7 days. When choosing a drug, preference should be given to modern complex preparations: probibor, linex, bifidumbacterin-forte, florin forte, etc.
Approximate terms of incapacity for work
With a light form - 7-10 days, with an average - up to 16-18 days, with severe form and complications - up to a month or more. Patients from the decreed group are not allowed to work until they have received two negative results of bacteriological examination of stool.
Dispensary supervision
Dispensary observation is subject to patients with chronic dysentery, workers of food enterprises and persons equal to them (for 3 months, and for chronic dysentery - for 6 months).
Memo for the patient
Shigellosis (dysentery) is an infectious disease that is transmitted by the food, water or contact-household way. For its prevention, it is necessary to comply with sanitary and hygienic standards, refrain from eating poor-quality food, raw water. Shigellosis is characterized by a rise in temperature, malaise, a loose stool, often with an admixture of mucus and blood, and abdominal pain. When these symptoms occur, you should immediately consult a doctor and start treatment for dysentery. Termination of treatment and entry into work are possible after the normalization of the condition and negative bacteriological analysis of feces, and for workers in the food industry, public catering and water supply institutions, children's institutions - two negative results of bacteriological tests.