Dysentery, Bacillary

Description

General Measures

Medicine Treatment

Referral

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ICD-10 code: A02.0/A02.9/A03.0-3/A03.8-9/A04.2-3/A04.5/A04.8-9

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

Fluid replacement in dehydration

Treat dehydration vigorously.

Children

Treat dehydration according to Section 2.9.1: Diarrhoea, acute in children.

Adults

If dehydration is not severe:

• Oral rehydration solution (ORS).

OR

• Homemade sugar and salt solution.

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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)

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Note:
- Oral rehydration volume will depend on the severity of dehydration.

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If dehydration is severe:

• Sodium chloride, 0.9%, IV.

OR

Ringers lactate, IV.

Antibiotic therapy

Indicated in:

• Children < 12 months of age.
• Children ≥ 1 year of age and adults with blood in the stools.
• All people living with HIV.

Children < 12 months of age

Give single dose of ceftriaxone and refer.

LoE:IVb¹³

• Ceftriaxone, IM/IV, 100 mg/kg/dose immediately as a single dose. See dosing table.
  • For IM administration: do not inject more than 1 g at one injection site.
  • For IV administration: Doses greater than 2 g must be given in two divided doses (i.e. 12 hourly), preferably by intravenous infusion over 30 minutes.

LoE:IVb¹⁴

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CAUTION: USE OF CEFTRIAXONE IN NEONATES AND CHILDREN

- If neonate is suspected to have a serious bacterial infection, give ceftriaxone, even if jaundiced.
- Avoid giving calcium-containing IV fluids (e.g. Ringers 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.

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Children ≥ 12 months of age

• Ciprofloxacin, oral, 15 mg/kg/dose 12 hourly for 3 days. See dosing tables.

Adults

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

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

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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.

Click here to access the pdf.

Click here for the  NEMLC Recommendations for medicine amendments (2020-4 review cycle).

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Standard Treatment Guidelines And Essential Medicines List For South Africa, Primary Healthcare, 2020-4_Version 1_June 2024

Chapter 2: Gastro-Intestinal Conditions, 2.10 Dysentery, 2.10.1 Dysentery, Bacillary