Shigellosis - Cure and Treatment

Shigellosis is an infection of the colon or the large intestine caused by a group of bacteria known as Shigella. The disease is usually characterized by fever, diarrhea, bloody stools, abdominal cramps and nausea even though some people infected by the bacteria may not display any symptoms or only very minor ones. Most of the symptoms of Shigellosis occur since the Shigella bacteria attack the inner lining of the large intestine, causing inflammation, ulcers and bleeding.

Shigellosis is usually curable even though the proper course of treatment is best decided by a doctor. Treatment usually follows one or a combination of the following steps:

1. In mild cases of shigellosis where there are no symptoms or only very minor ones, doctors usually advise the patient lots of rest, adequate hydration and easily digested foods. Antibiotics need not be given if the diarrhea is found to subside on its own. Rather the focus of the treatment is to prevent dehydration and the spread of infection to others.
    
2. However if the diarrhea is severe and the fever is very high, the doctor may put the patient on a course of antibiotics. Here it is important to be guided by a certified medical professional and avoid self-prescription even in places where antibiotics are available over the counter. This is because many infections of the digestive tract present symptoms similar to those produced in a shigellosis patient and only a doctor, through clinical observation and diagnostic tests, is qualified to prescribe the correct course of treatment. Stomach upsets caused by a viral flu may not respond to antibiotics at all while even for shigella, there are different strains of the bacteria which best respond to different antibiotics. then again increasing resistance of bacteria to commonly prescribed drugs makes anti-biotic testing necessary for effective treatment and management in case of infections like shigellosis. For all these reasons it is best to refer to a doctor. Usually shigellosis is treated by antibiotics like ampicillin, trimethoprim/sulfamethoxazole also known by their brand name as Bactrim or Septra, and ceftriaxone or Rocephin. In case of adults, a doctor may also prescribe ciprofloxacin but because of serious side-effects associated with this drug it is not recommended for children. Antibiotic treatment is usually recommended for infirm or older patients, malnourished children, patients infected with HIV, food handlers, health care workers, and children in day care centers.
    
3. However a potential drawback of antibiotics is that its indiscriminate use can lead to resistance to the infection-causing bacteria. The website of Centers for Disease Control and Prevention 1 mentions that some strains of Shigella bacteria have already become resistant to antibiotics and no longer respond to treatment by the commonly prescribed antibiotics. In fact, using antibiotics to treat shigellosis can sometimes make the germs more resistant. For instance Ampicillin which was widely used in the past, is no longer an effective empiric treatment in the United States and many parts of the world because of antibiotic resistance. Given the widespread resistance to ciprofloxacin as well as trimethoprim-sulfamethoxazole and azithromycin, a third-generation cephalosporin sometimes considered as appropriate empiric therapy in cases of acute illness. The treatment of choice for HIV-infected patients is usually a quinolone for 5 days.  also in cases where the infection is widespread in a community, only those people who develop the most severe symptoms or are in danger of complications are treated with antibiotics.
    
4. Since one of the major symptoms of Shigellosis is diarrhea, people may be led to take anti-diarrheal medications, some of which are sold over the counter. However this could be dangerous since anti-diarrheal agents such as loperamide sold as Imodium or diphenoxylate with atropine available as Lomotil can make the illness worse and predispose the colon to toxic dilation.
    
5. When shigellosis leads to high fever, particularly in children, the doctor may prescribe safe medications like acetaminophen. This will bring down the fever and make the child more comfortable though it will not treat the source of the infection.
    
6. If there is evidence of dehydration in the patient and especially in children, the doctor may advise greater intake of fluids or oral rehydration compositions. This is because dehydration can lead to loss of essential fluids and salts from the body which in turn can adversely affect major organs like heart, brain and kidney.
    
7. During episodes of shigellosis, the recommended diet usually consists of clear liquids followed by low residue and lactose-free foods and drinks.
    
8. An essential aspect of Shigellosis treatment involves practicing hygienic habits which will not only help shorten the duration of the infection but more importantly prevent the spread of infection to others, whether in the family or the larger community. for this the patient needs to wash their hands with soap:

• every time after using the toilet
   
• before eating or drinking anything
   
• ideally people with shigellosis should not prepare food or drinks for others or feed others until they have been shown to no longer be carrying the Shigella bacterium, or if they have had no diarrhea for at least 2 days. However those who are in contact with patients of shigellosis it is necessary to wash hands well with soap before preparing food or feeding others.
   
• In case of caregivers who are looking after a child with shigellosis, it is necessary to wash hands after changing the child’s diapers or washing him/her up after a bowel movement. Also the diapers should be disposed of properly in a closed-lid garbage can and child’s hands too should be washed with germicidal soap. After use, the diaper changing area should be wiped down with a disinfectant such as diluted household bleach or bactericidal wipes. When possible, young children with a Shigella infection who are still in diapers should not be in contact with uninfected children.
   
• At swimming pools and beaches, having enough bathrooms and hand-washing stations with soap near the swimming area will go a long way in keeping the water from becoming contaminated. Also daycare centers should not provide water play areas.
   
• For those people traveling to the developing world, simple precautions taken to prevent traveler's diarrhea can be equally effective in preventing shigellosis; these measures include drinking only treated or boiled water and eat only fully-cooked hot foods or fruits that they peel themselves.