In this article, we will discuss the Management of Acute Dysentery. So, let’s get started.
The bacillary dysentery has to be differentiated from amoebic dysentery from the therapeutic point of view. The stools are to be examined for trophozoites, pus cells, RBCs and culture be immediately sent. The steps of management include:
1. Assessment of dehydration should be done and oral rehydration therapy (WHO / UNICEF solution) may be started if dysentery is mild or moderate. In severe cases intravenous fluids and electrolytes should be given to correct fluid and electrolyte deficit. The pulse, blood pressure, urine output, temperature and electrolytes should be monitored. Antimicrobial therapy ciprofloxacin 750 mg bid for 7 days or levofloxacin 500 mg daily for 3 days is drug of choice in bacillary dysentery; ceftriaxone and azithromycin are alternatives.
2. Amoebic dysentery needs metronidazole 800 mg 8 hourly for 5 days or tinidazole single dose of 2 gram daily for 3 days. Diloxanide furoate mg should be given orally 8 hourly for 10 days to eliminate the luminal cyst.
3. Before starting specific treatment and before the stool culture report an empirical treatment with ciprofloxacin plus metronidazole or tinidazole is advised. The treatment is to be revised after report of stool culture.
4. Antimotility drugs should be avoided.
5. Treatment of complications:
- (A) Toxic megacolon
- Correct dehydration, anemia and electrolyte
- Nasogastric aspiration
- Parenteral nutrition and antibiotics
- Surgery if above medical treatment fails
- (B) Hemolytic uremic syndrome
- Water and salt restriction (discontinue ORS)
- Hemofiltration if needed