Materiały źródłowe

• #1 Treatment of Shigella Infection | Shigella – Shigellosis | CDC

  https://www.cdc.gov/shigella/treatment/index.html

  People with Shigella infection usually get better without antibiotic treatment in 5 to 7 days. […] People with mild shigellosis may need only fluids and rest. […] Healthcare providers may prescribe antibiotics for people with severe cases of shigellosis to help them get better faster. […] Tell your healthcare provider if you do not get better within a couple of days after starting antibiotics. […] Antibiotics can shorten the time you have fever and diarrhea by about 2 days. […] Ciprofloxacin and azithromycin are two recommended oral antibiotics. […] If your healthcare provider prescribes an antibiotic, take it exactly as directed and finish taking all the pills even if you feel better.

• #2 Shigella infection – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/shigella/diagnosis-treatment/drc-20377533

  Treatment for shigella infection depends on how serious the illness is. Most often, the illness is mild and gets better within seven days. You may only need to replace lost fluids from diarrhea, especially if your overall health is good. […] If a lab test has confirmed that you have shigella infection, medicine that contains bismuth subsalicylate (Pepto-Bismol, Kaopectate) may help. This is available without a prescription. It may help you pass stool less often and shorten the length of your illness. But it isn’t recommended for children, pregnant or breastfeeding people, or people who are allergic to aspirin. […] Do not take diarrhea medicines such as loperamide (Imodium A-D). Also, do not take medicines that contain the combination of diphenoxylate and atropine (Lomotil). These aren’t recommended for shigella infection. They can lower the body’s ability to clear shigella germs and make your condition worse.

• #3 About Shigella Infection | Shigella – Shigellosis | CDC

  https://www.cdc.gov/shigella/about/index.html

  People who have shigellosis usually get better without antibiotic treatment in 5 to 7 days. […] Your healthcare provider may prescribe medicine to treat illness caused by Shigella. […] If you have diarrhea, drink a lot of water or other fluids to avoid dehydration (loss of fluids).

• #4 Antibiotic therapy for Shigella dysentery

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6532574/

  Antibiotics reduce the duration of Shigella dysentery. […] Regularly updated local or regional antibiotic sensitivity patterns to different species and strains of Shigella are required to guide empiric therapy. More trials adhering to standard guidelines are required to evaluate the role of antibiotics in the treatment of severe forms of Shigella dysentery and in groups who are at high risk of complications. […] The World Health Organization (WHO) recommends that all suspected cases of shigellosis based on clinical features be treated with effective antimicrobials (antibiotics). […] The WHO now recommends that clinically diagnosed cases of Shigella dysentery be treated with ciprofloxacin as first line treatment, and pivmecillinam, ceftriaxone, or azithromycin as second line treatment and lists the others as ineffective.

• #5 Antibiotic therapy for Shigella dysentery

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6532574/

  When an effective antibiotic is given, clinical improvement is anticipated within 48 hours. This lessens the risk of serious complications and death, shortens the duration of symptoms, and hastens the elimination of Shigella and the subsequent spread of infection. […] The intention of giving antibiotics in shigellosis is to speed recovery, reduce the seriousness of the disease, and reduce the length of time patients are infective. However, some antibiotics can have serious side effects while others may not be effective against the Shigella bacteria. […] The review examined both the effectiveness and the safety of antibiotics in treating Shigella dysentery. While antibiotics tested here appeared safe and effective, there was insufficient evidence to suggest which antibiotics were superior. More well-designed trials will help inform decision making.

• #6 Guidelines for the treatment of dysentery (shigellosis): a systematic review of the evidence

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6021764/

  With effective antibiotic therapy, clinical improvement occurs within 48 h, resulting in a decreased risk of serious complications and death, shorter duration of symptoms, and the elimination of shigella from the stool. […] The more recently published 2013 WHO Pocketbook of Hospital Care for Children included a chapter on the treatment of shigella dysentery, with recommendations which were the same as in the 2005 guidelines. […] The authors concluded that there is strong evidence that current antimicrobial guidelines are effective in preventing serious mortality and morbidity. […] However, all studies were hospital-based which limits the information available on resistance patterns for shigella infections typically treated within the community. […] A systematic review in 2013 used CHERG standard rules to analyse 48 high-quality randomised controlled trials in children aged 16 years mainly in low- and middle-income countries (LMIC), seven of which were ultimately eligible for inclusion.

• #7 Shigellosis Treatment & Management: Approach Considerations, Medical Care, Prevention

  https://emedicine.medscape.com/article/182767-treatment

  Maintain hydration in patients with shigellosis to compensate for fluid losses from diarrhea. […] Antibiotic treatment is indicated in most patients with a positive stool culture for Shigella. Treatment can reduce symptoms by 2 days. […] Indications for treatment per Centers for Disease Control and Prevention (CDC) recommendations include persons who work in public setting (ie, food handlers, childcare providers, residents of nursing homes), have a immunocompromised state (including individuals with human immunodeficiency virus [HIV] infection), and patients with severe disease (those who require hospitalization or have complications). […] Avoid the use of antimotility agents, because they have the potential to worsen the symptoms and may predispose to toxic dilatation of the colon. […] Clear liquids followed by a low residue, lactose-free diet are recommended until symptoms of shigellosis resolve.

• #8 For health professionals: Shigellosis (Shigella) – Canada.ca

  https://www.canada.ca/en/public-health/services/diseases/shigella/health-professionals.html

  Most patients recover without complications within 5 to 7 days without specific treatment. […] With proper oral rehydration or electrolyte replacement, shigellosis is generally a self-limiting disease. Fluid replacement is essential in dehydrated patients and can lead to recovery within days. This is particularly important for seniors, children and those with weakened immune systems. In severe cases, patients may need to be given fluids intravenously. […] Antibiotics are prescribed based on the severity of disease, the age of the patient and the likelihood of further transmission of the infection. […] For severe cases of shigellosis, particularly, involving Shigella dysenteriae, antibiotics may be required. […] Effective antibiotic treatment reduces the average duration of illness from approximately 5 to 7 days to approximately 3 days and also reduces the period of Shigella excretion after symptoms subside.

• #9

  https://www.healio.com/news/infectious-disease/20230713/a-treatment-dilemma-extensively-drugresistant-shigella

  Supportive care is recommended for all patients with shigellosis, and that may be all that is needed for those with mild illness. Hydration and maintenance of electrolytes through oral hydration is usually sufficient treatment for these patients. Antidiarrheal agents such as loperamide should be avoided because they could prolong symptoms and bacterial shedding. […] Antibiotic therapy can help reduce the duration of illness by 1 to 2 days and help prevent secondary transmission. Antibiotic treatment is recommended for patients with severe illness or risk factors for progression of symptoms such as immunocompromised patients. […] Treatment guidelines for shigellosis are available from the Infectious Diseases Society of America and WHO. Although oral antibiotics can be used for most patients, IV ceftriaxone can be considered for those with severe disease or immunocompromising conditions.

• #10 CDC Offers Recommendations for Treatment of Shigella Infection | Consultant360

  https://www.consultant360.com/exclusives/cdc-offers-recommendations-treatment-shigella-infection

  Shigella infections should not be treated with antibiotics unless clinically indicated, as in patients who are immunocompromised or have severe illness, or during an outbreak, according to recent recommendations from the CDC. […] The CDC recommends that clinicians: […] Do not routinely prescribe antibiotics for Shigella. Instead, reserve antibiotic therapy for patients in which it is clinically indicated, or during an outbreak. […] When antibiotics are indicated, tailor the choice of antibiotic to antimicrobial susceptibility results as soon as possible. […] The CDC plans to investigate in clinical outcomes are worse in patients infected with resistant Shigella strains who receive ciprofloxacin treatment, and continue to monitor antimicrobial susceptibility of Shigella.

• #11 Shigella Advisory for Health Care Providers – Jan. 23. 2025 | Spokane Regional Health District

  https://srhd.org/shigella-advisory-for-health-care-providers-jan-23-2025

  Although antibiotic therapy is not routinely recommended for mild infections, consider antibiotic treatment for: […] Fluoroquinolones (such as ciprofloxacin), azithromycin, and third-generation cephalosporins (such as ceftriaxone) are recommended antibiotics. […] Healthcare providers should consult with a specialist knowledgeable in the treatment of antibiotic-resistant bacteria to determine the best treatment option if there are concerns for XDR Shigella infections or in cases of treatment failure without AST results. […] CDC does not have recommendations for optimal antimicrobial treatment because there are no data from clinical studies of treatment of XDR Shigella infections.

• #12 Shigella Infection (Shigellosis): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17826-shigellosis

  Treatment for Shigella depends on how severe it is. […] If your symptoms are mild, you can treat it with rest and by drinking fluids to prevent dehydration (a dangerous loss of water in your body). […] In more severe cases of shigellosis, and for people with weak immune systems, doctors may prescribe an antibiotic to treat the infection. Your provider may prescribe ciprofloxacin or azithromycin. […] Make sure you follow directions and take all of the antibiotics even if you start feeling better before theyre gone.

• #13 Shigella infection – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/shigella/diagnosis-treatment/drc-20377533

  For a serious shigella infection, your healthcare professional may recommend medicines called antibiotics that help get rid of germs. Antibiotics may shorten the length of the illness. But some shigella bacteria resist the effects of these medicines. So your healthcare professional may not recommend antibiotics unless your shigella infection is very bad. […] Antibiotics also may be needed to treat infants, older adults and people with weakened immune systems. Antibiotics also may be used if there’s a high risk of spreading the disease. […] If you’re given antibiotics, take them exactly as prescribed. Finish taking all the pills even if you start to feel better. […] For adults in good health overall, drinking water may be enough to prevent dehydration caused by diarrhea. […] Children may benefit from a treatment called oral rehydration solution, such as Pedialyte. This is sold in drugstores and taken by mouth. Many pharmacies carry their own brands.

• #14 Shigella infection – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/shigella/diagnosis-treatment/drc-20377533

  Children and adults who are very dehydrated need treatment in a hospital emergency room. Treatment involves salts and fluids given through a vein rather than by mouth. This is called intravenous hydration. It provides the body with water and essential nutrients much more quickly than oral solutions do.

• #15 Shigella infection | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/shigella-infection?content_id=CON-20377512

  Most often, shigella infection clears up on its own within a week. Treatment for serious illness may include medicines called antibiotics that get rid of the germs. […] For a serious shigella infection, your healthcare professional may recommend medicines called antibiotics that help get rid of germs. Antibiotics may shorten the length of the illness. But some shigella bacteria resist the effects of these medicines. So your healthcare professional may not recommend antibiotics unless your shigella infection is very bad. […] If you’re given antibiotics, take them exactly as prescribed. Finish taking all the pills even if you start to feel better. […] For adults in good health overall, drinking water may be enough to prevent dehydration caused by diarrhea. […] Children may benefit from a treatment called oral rehydration solution, such as Pedialyte. This is sold in drugstores and taken by mouth. Many pharmacies carry their own brands.

• #16 Shigella infection | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/shigella-infection?content_id=CON-20377512

  Children and adults who are very dehydrated need treatment in a hospital emergency room. Treatment involves salts and fluids given through a vein rather than by mouth. This is called intravenous hydration. It provides the body with water and essential nutrients much more quickly than oral solutions do.

• #17 Shigella Infection Medication: Antibiotics, Trace Elements/Metals

  https://emedicine.medscape.com/article/968773-medication

  WHO has introduced the use of zinc for 10-14 days as part of a diarrheal disease control program in addition to oral rehydration therapy. Initiating zinc at the time of diarrhea leads to shorter duration and fewer loose stools. […] A child with typical dysentery that responds to initial empirical antibiotic treatment should continue taking the same drug for a full 5-day course, even if the stool culture is negative.

• #18 Guidelines for the treatment of dysentery (shigellosis): a systematic review of the evidence

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6021764/

  Current WHO guidelines support the use of fluoroquinolones (first-line), -lactams (second-line) and cephalosporins (second-line) which accords with currently available evidence and other international guidelines, and there is no strong evidence for changing this guidance. […] Azithromycin is appropriate as a second-line therapy in regions where the rate of non-susceptibility of ciprofloxacin is known to be high, and research suggests that, from a cardiac point of view, azithromycin is safer than other macrolide antibiotics. […] Cefixime is also a reasonable alternative, although its use must be weighed against the risk of dissemination of extended-spectrum -lactamase-producing organisms. […] Current guidelines for treating shigella were published by WHO in 2005 and they recommend ciprofloxacin as the first-line treatment.

• #19 Antibiotic therapy for Shigella dysentery

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6532574/

  Antibiotics reduce the duration of Shigella dysentery. […] Regularly updated local or regional antibiotic sensitivity patterns to different species and strains of Shigella are required to guide empiric therapy. More trials adhering to standard guidelines are required to evaluate the role of antibiotics in the treatment of severe forms of Shigella dysentery and in groups who are at high risk of complications. […] The World Health Organization (WHO) recommends that all suspected cases of shigellosis based on clinical features be treated with effective antimicrobials (antibiotics). […] The WHO now recommends that clinically diagnosed cases of Shigella dysentery be treated with ciprofloxacin as first line treatment, and pivmecillinam, ceftriaxone, or azithromycin as second line treatment and lists the others as ineffective.

• #20 Shigella Infection Medication: Antibiotics, Trace Elements/Metals

  https://emedicine.medscape.com/article/968773-medication

  Various antimicrobial agents are effective in the treatment of shigellosis, although options are becoming limited because of globally emerging drug resistance. Resistance of Shigella species to sulfonamides, tetracyclines, ampicillin, and trimethoprim-sulfamethoxazole (TMP-SMX) has been reported worldwide, and these agents are not recommended as empirical therapy. […] The World Health Organization (WHO) recommends that all suspected cases of shigellosis based on clinical features be treated with effective antimicrobials (antibiotics). […] The following antibiotics are used to treat Shigella dysentery: Beta-lactams: Ampicillin, amoxicillin, third-generation cephalosporins (cexime, ceftriaxone), and pivmecillinam (not available in the United States) […] Quinolones: Nalidixic acid, ciprooxacin, noroxacin, and ooxacin

• #21 Shigella Infection Medication: Antibiotics, Trace Elements/Metals

  https://emedicine.medscape.com/article/968773-medication

  Macrolides: Azithromycin […] Others: sulfonamides, tetracycline, cotrimoxazole, and furazolidone. […] If an ampicillin and TMP-SMX resistant strain is isolated or if susceptibility is unknown, parenteral ceftriaxone sodium, fluoroquinolone (eg, ciprofloxacin, ofloxacin), azithromycin dihydrate (off-label indication), or oral cefixime are the drugs of choice. […] Because shigellosis is self-limiting, some authorities recommend withholding antibiotic therapy. When an effective antibiotic is given, clinical improvement is anticipated within 48 hours. […] Antimicrobial therapy is typically administered for 5 days. Antibiotic treatment decreases the duration of illness, person-to-person spread, and cases in household contacts. […] Antidiarrheal medications (diphenoxylate hydrochloride with atropine [Lomotil] or loperamide [Imodium]) should not be used because of the risk of prolonging the illness.

• #22 Guidelines for the treatment of dysentery (shigellosis): a systematic review of the evidence

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6021764/

  It was reported that ciprofloxacin, pivmecillinam or ceftriaxone successfully cleared shigella pathogens in 96% of cases. […] In view of the research above documenting increasing resistance to ciprofloxacin and ceftriaxone, the international literature was reviewed for alternative antimicrobials that might be used for shigella dysentery. […] A 2010 Cochrane review investigated antibiotic therapy for shigella dysentery but found no superior efficacy when comparing fluoroquinolones, -lactams or macrolides. […] The authors noted that the current practice of presumptively treating shigella dysentery with antibiotics should continue because of the public health benefits conferred, but that no specific antibiotic, or antibiotic class, is universally effective for shigella. […] Azithromycin, a macrolide antibiotic, is listed as an alternative second-line therapy for adults in current WHO guidelines as well as in most international guidelines.

• #23 Guidelines for the treatment of dysentery (shigellosis): a systematic review of the evidence

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6021764/

  Cefixime has been demonstrated to be effective (at 8 mg/kg/day in two divided doses) for shigellosis in adults and paediatric patients. […] Updated clinical trials to investigate this therapy as an alternative treatment option are urgently needed because previous randomised controlled trials investigating its efficacy are over a decade old. […] The guidelines also note that oral cephalosporins (cefixime) have been used successfully in treating shigellosis in adults.

• #24 Treatment for Shigella Infection | Marler Clark

  https://marlerclark.com/foodborne-illnesses/shigella/shigella-treatment

  Anyone with a suspected Shigella infection should be tested for the presence of Shigella bacteria. Antibiotics can shorten the length of illness. […] Although shigellosis is usually a self-limiting illness, antibiotics can shorten the course, and in severe cases, might be life-saving. Historically, the antibiotics commonly used for treatment of bacterial infections, like those caused by Shigella, were ampicillin, trimethoprim/sulfamethoxazole (TMP-SMZ, also known as Bactrim or Septra), or ceftriaxone (Rocephin). Ciprofloxacin is also commonly used to treat adults who are infected. […] Recently, the World Health Organization (WHO) named Shigella as one of the eight priority pathogens in its Global Antimicrobial Resistance Surveillance System (GLASS) platform. The early implementation report from GLASS surveillance in 2020 revealed the following antibiotics as acceptable for use in shigellosis cases: fluoroquinolones (ciprofloxacin or levofloxacin), third-generation cephalosporins (ceftriaxone, cefotaxime, or ceftazidime), and macrolides (azithromycin).

• #25 Shigellosis | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CG/english/shigellosis-16689596.html

  Patients with signs of serious illness or with life-threatening risk factors must be admitted as inpatients. […] Treat patients with neither signs of serious illness nor risk factors as outpatients. […] Antibiotherapy: First-line treatment ciprofloxacin PO for 3 days Children: 15 mg/kg 2 times daily (max. 1 g daily) Adults: 500 mg 2 times daily if the strain is sensitive if there is no antibiotic sensitivity test if oral administration is possible. […] ceftriaxone IM for 3 days Children: 50 to 100 mg/kg once daily (max. 1 g daily) Adults: 1 to 2 g once daily in patients with severe infection and/or oral administration is not possible in pregnant women. […] If resistance or contra-indication to ciprofloxacin or if no improvement within 48 hours of starting first-line treatment: azithromycin PO for 5 days Children: one dose of 12 mg/kg on D1 then 6 mg/kg once daily from D2 to D5 Adults: one dose of 500 mg on D1 then 250 mg once daily from D2 to D5 or cefixime PO for 5 days Children: 8 mg/kg once daily (max. 400 mg daily) Adults: 400 mg once daily.

• #26 Shigellosis | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CG/english/shigellosis-16689596.html

  If there is no improvement 48 hours after starting second-line treatment, treat for amoebiasis. […] For pain and/or fever: paracetamol PO. All opioid analgesics are contra-indicated as they slow peristalsis. […] Supportive therapy: nutrition: nutritional supplement with frequent meals + 2500 kcal daily during hospitalisation + 1000 kcal daily as outpatients, rehydration: administration of ORS according to WHO protocols, zinc supplement in children under 5 years. […] Never give loperamide or any other antidiarrhoeal. […] Management of complications: rectal prolapse reduction, septicaemia, etc.

• #27 Guidelines for the treatment of dysentery (shigellosis): a systematic review of the evidence

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6021764/

  The guidelines also noted that pivmecillinam (amdinocillin pivoxil) and ceftriaxone were the only antimicrobials that are usually effective for the treatment of multi-resistant strains of Shigella in all age groups, yet their usage is limited by their high cost and formulation. […] Azithromycin was included as a second-line therapy for adults. […] The 2005 guidelines also listed antimicrobials which should not be used to treat shigellosis owing to their poor mucosal penetration or increasing antimicrobial resistance. […] Current guidelines are therefore based on evidence which is increasingly outdated. […] In view of changing patterns of resistance to antimicrobials worldwide, this systematic review was undertaken to evaluate the current international literature on the treatment of shigellosis in children.

• #28 CDC Recommendations for Managing and Reporting Shigella Infections

  https://www.idsociety.org/news–publications-new/cdc-alerts/cdc-recommendations-for-managing-and-reporting-shigella-infections/

  This Health Alert Network (HAN) Update provides current recommendations on management and reporting of Shigella infections that have been treated with ciprofloxacin or azithromycin and resulted in possible clinical treatment failure. […] Clinicians should carefully monitor patients with Shigella infections who require fluoroquinolone treatment and report any possible treatment failures. If treatment failure is suspected, clinicians should submit a stool specimen for antimicrobial susceptibility testing, and consider consulting an infectious disease specialist to identify best treatment options. […] If you identify or receive a report of a patient with Shigella infection and possible fluoroquinolone or azithromycin treatment failure: Consider consulting an infectious disease specialist to identify other treatment options, because some Shigella isolates with susceptible ciprofloxacin MICs may harbor one or more quinolone resistance mechanisms.

• #29 CDC Recommendations for Managing and Reporting Shigella Infections

  https://www.idsociety.org/news–publications-new/cdc-alerts/cdc-recommendations-for-managing-and-reporting-shigella-infections/

  CDC is working with CLSI and other partners to collect isolates and clinical information from people with Shigella infection and possible clinical treatment failure occurring after treatment with a fluoroquinolone or azithromycin. If treatment failure is suspected, clinicians should consider consulting an infectious disease specialist to identify best treatment options, and submit a stool specimen for antimicrobial susceptibility testing. Clinicians should monitor patients carefully and report cases of possible clinical treatment failure to CDC.

• #30 Suspected Local Transmission of Extensively Drug-Resistant (XDR) Shigellosis in King County – King County, Washington

  https://kingcounty.gov/en/dept/dph/health-safety/disease-illness/health-advisories/2024/april-5

  Although antibiotic therapy is not routinely recommended for mild infections, it should be prescribed for patients with more severe illnesses, patients who are immunocompromised, patients in settings where there is elevated concern about transmission to others (e.g., in congregate living situations) and in outbreak settings (consult with Public Health). […] Healthcare providers should consult with a specialist knowledgeable in the treatment of antibiotic-resistant bacteria to determine the best treatment option if there are concerns for XDR Shigella infections or in cases of treatment failure without AST results. […] Because there are no data from clinical studies of treatment of XDR Shigella infections, CDC does not have recommendations for optimal antimicrobial treatment. Healthcare providers should consult with a specialist knowledgeable in the treatment of antibiotic-resistant bacteria to determine the best treatment option if there are concerns for XDR Shigella infections or in cases of treatment failure without antimicrobial sensitivity testing (AST) results.

• #31

  https://www.healio.com/news/infectious-disease/20230713/a-treatment-dilemma-extensively-drugresistant-shigella

  The challenge with XDR Shigella is that these isolates are resistant to all of the recommended antibiotics, and data are lacking on optimal treatment options with these isolates. […] Fosfomycin and meropenem may prove to be options for XDR Shigella infections, but robust clinical data are lacking at this time. […] Meropenem or ertapenem was recommended as IV treatment options for hospitalized patients with suspected or confirmed cases with complications or severe infection. […] When antimicrobial susceptibility testing results are available, this should guide treatment options. However, for confirmed or suspected XDR isolates, consultation with an infectious diseases specialist is recommended because of limited available treatment options for these patients.

• #32 Extensively drug-resistant Shigella infections are increasing. Here’s what you need to know. » Emerging Pathogens Institute » University of Florida

  https://epi.ufl.edu/2023/03/10/extensively-drug-resistant-shigella-infections-are-increasing-heres-what-you-need-to-know/

  Extensively drug-resistant shigellosis is not curbed by three different classes of common antibiotics macrolide, quinolone and cephalosporins and it does not respond to common antibiotic alternatives. Researchers are in the process of developing effective treatments. Antibiotics from the carbapenem class may be useful, according to Emerging Pathogens Institute Director J. Glenn Morris, Jr., M.D. […] For most people, the disease resolves itself without treatment. We dont even know if someone has the drug-resistant strain unless certain clinical tests are done. Healthy individuals with working immune systems generally do not require antibiotics. […] But for people with compromised immune systems, children under five and the elderly, antibiotics may be recommended by a clinician to shorten the length of illness. This reduces the amount of infectious bacteria coming out of the individual, which helps protect others around them.

• #33 Shigella: Symptoms, Causes, and Treatment

  https://www.webmd.com/food-recipes/food-poisoning/what-is-shigella

  In most cases, you can feel better from shigellosis by resting and drinking fluids to replace what you’ve lost from diarrhea. […] Avoid drugs that stop diarrhea or slow down the gut. Drugs such as diphenoxylate with atropine (Lomotil) or loperamide (Imodium) can make shigellosis worse. […] In severe cases, your doctor may prescribe antibiotics to shorten the illness. This may be for seniors, infants, or people who have other diseases. Some shigella bacteria are resistant to antibiotics, so the treatment may not work. […] Tell your doctor if prescription antibiotics don’t make you feel better after you’ve taken them for several days.

• #34 Shigellosis Treatment & Management: Approach Considerations, Medical Care, Prevention

  https://emedicine.medscape.com/article/182767-treatment

  Antibiotic treatment is indicated in most patients. […] Clear liquids followed by a low-residue, lactose-free diet is recommended until symptoms of shigellosis resolve. […] As noted earlier, antimotility agents should be avoided, as they have the potential to worsen symptoms and may predispose to toxic dilatation of the colon. […] For fluid and electrolyte supplementation, oral rehydration solutions are preferable. […] Consult a gastroenterologist or an infectious diseases expert if the Shigella infection is prolonged or if the patient experiences a severe course of shigellosis that is unresponsive to antibiotics.

• #35 Shigellosis

  https://dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/diseases/shigellosis.html

  Shigella infections are treated with antibiotics. The most commonly used antibiotics are ampicillin, trimethoprim/sulfamethoxazole, nalidixic acid or ciprofloxacin. Appropriate treatment kills the Shigella bacteria that might be present in a patient’s stools and shortens the illness. […] Unfortunately, some Shigella bacteria have become resistant to antibiotics and using antibiotics to treat shigellosis can actually make the germs more resistant in the future. […] Persons with mild infections will usually recover quickly without antibiotic treatment. Therefore, when many persons in a community are affected by shigellosis, antibiotics are sometimes used selectively to treat only the more severe cases. Antidiarrheal agents (e.g., loperamide or diphenoxylate with atropine) are likely to make the illness worse and should be avoided.

• #36 Shigellosis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/gram-negative-bacilli/shigellosis

  Treatment of mild infection is supportive, mostly with rehydration; antibiotics (eg, ciprofloxacin, azithromycin, ceftriaxone) are given to moderate to severely ill and high-risk patients with bloody diarrhea or immunocompromise and may shorten the duration of illness and decrease contagiousness. […] For severely ill or at-risk patients, a fluoroquinolone, azithromycin, or a third-generation cephalosporin. […] Fluid loss due to shigellosis is treated symptomatically with oral or IV fluids. […] Antidiarrheal medications (eg, loperamide) may prolong illness and should not be used. […] Antibiotics can reduce the symptoms and shedding of Shigella but are not necessary for healthy adults with mild illness. However, certain patients, including the following, should usually be treated: Children, Older adults, Patients with immunocompromise, Patients with moderate to severe disease.

• #37 Shigella Infections (Shigellosis) (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/shigella.html

  To see if your child has shigellosis, the doctor will take a stool sample to test for Shigella bacteria. […] Shigellosis often goes away without treatment. Doctors sometimes give antibiotics to those who have serious symptoms or other medical conditions. Antibiotics can shorten the illness and help prevent the spread of bacteria to others. […] If the doctor prescribes antibiotics, give them as prescribed. Don’t give your child nonprescription medicines for vomiting or diarrhea unless the doctor recommends them because they can make the illness last longer. You can give acetaminophen (such as Tylenol) to reduce fever and make your child more comfortable. […] To prevent dehydration, follow your doctor’s advice about what your child should eat and drink. Your doctor may recommend a special drink called an oral rehydration solution (such as Pedialyte) to replace lost body fluids. […] Children who get dehydrated or those with more serious symptoms may need treatment in a hospital.

• #38

  https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/Shigella-Infections.aspx

  If your childs symptoms are mild, your pediatrician may decide that its not necessary to prescribe medicine to treat the infection. […] However, antibiotics such as cefixime, ampicillin, or trimethoprim sulfamethoxazole may be prescribed in more severe cases. […] These drugs can kill Shigella bacteria in the childs stools, shorten the duration of the diarrhea, and lower the chances of spreading the illness. […] If your child is having lots of watery diarrhea, be sure to give her extra fluids to avoid dehydration. […] In severe cases, intravenous fluids may be required. […] Do not self-prescribe antidiarrheal medicines, which can actually make your child worse.

• #39 Shigella infection – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/shigella/symptoms-causes/syc-20377529

  Most often, shigella infection clears up on its own within a week. Treatment for serious illness may include medicines called antibiotics that get rid of the germs. […] If you have a weakened immune system, call your healthcare professional if you have any shigella infection symptoms. The illness is more likely to make you sick for a longer time.

• #40 Shigella infection – including symptoms, treatment and prevention | SA Health

  https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/shigella+infection/shigella+infection+-+including+symptoms+treatment+and+prevention

  Specific antibiotic therapy is available and will reduce the duration and severity of symptoms and the spread of infection. Gastroenteritis is a common illness which can be particularly serious in young children. […] The following are general recommendations for the treatment of gastroenteritis: give plenty of fluids. Oral rehydration solution is highly recommended for children with mild to moderate dehydration. It is available at pharmacies and should be administered following the instructions on the packaging […] medicines to prevent vomiting or diarrhoea should not be given (especially in children), except where specifically advised by a doctor […] After appropriate antibiotics, Shigella stop being shed in the faeces within a few days.

• #41 Shigellosis | Doctor

  https://patient.info/doctor/shigellosis

  When diarrhoea has settled, the vast majority are not a risk to others and may return to work with no further testing. General advice for those with an episode of gastroenteritis is that they may return to work or a school/childcare facility 48 hours after the last episode of diarrhoea or vomiting. […] The Food Standards Agency advises for food handlers, this applies to those with confirmed infection with S. sonnei, but that for S. dysenteriae, S. flexneri and S. boydii further measures are required. Guidelines advise that: „In addition to the normal 48-hour exclusion, people handling and serving open ready-to-eat foods should seek medical clearance. […] Complications are uncommon but may include the following: Dehydration and electrolyte disturbance may occur. Occasionally where not rectified, this can have fatal consequences. Infants, the elderly and those with immunological compromise are more likely to have more severe disease and to require admission to hospital for rehydration. Pregnant women are also more at risk of dehydration.

• #42 WHO EMRO | Shigella: risk communication and community engagement guidance | Publications | Health Emergency Preparedness and Internat

  https://www.emro.who.int/cpi/publications/shigella-risk-communication-and-community-engagement-guidance.html

  Zinc supplements: Consider zinc supplements for children aged 6 months to 5 years. […] Monitor for complications such as hypokalaemia (low potassium levels), hyponatremia (low sodium levels), hypoglycaemia (low blood sugar), seizures (due electrolyte imbalances) and encephalopathy (brain dysfunction due to toxins or infection). Long-term complications include persistent diarrhoea and prolonged malnutrition which may cause stunting and wasting in children. […] Hemolytic-uremic syndrome (HUS): A rare but severe complication of shigella infection, HUS destroys red blood cells, leading to kidney failure, and is a notable risk in cases involving Shiga-toxin-producing shigella, primarily in young children.

• #43 Phage Therapy for Shigella Infection

  https://www.phagetherapycenter.com/pii/PatientServlet?command=responsive_shigella

  Shigellosis can be treated with antibiotics, although some strains have developed drug resistance. […] Shigellosis usually resolves in 5 to 7 days. […] A severe infection with high fever may be associated with seizures in children less than 2 years old.

• #44 Shigellosis Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/shigellosis/

  Shigellosis is usually treated with antibiotics. But some types of Shigella bacteria are not killed by antibiotics. This is called resistance. Because using antibiotics can make these bacteria even more resistant, mild cases of shigellosis are often not treated with antibiotics. In this case, shigellosis is treated by managing complications until it passes. Dehydration caused by diarrhea is the most common complication. Do not use medicines to prevent diarrhea. […] To prevent dehydration, take frequent sips of a rehydration drink (such as Pedialyte). Soda and fruit juices have too much sugar and not enough of the important electrolytes that are lost during diarrhea. These kinds of drinks should not be used to rehydrate. […] When you feel like eating, start with small amounts of food. This will help you get enough nutrition.

• #45 Shigella infection – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1174

  Shigella infection is easily spread by faecal-oral contact or by contaminated water or food. It usually presents as a mild, self-limiting diarrhoeal illness. […] Treatment is usually supportive in mild cases. Antibiotics may be useful to shorten the course of the illness and reduce shedding of the organism in stool. […] Empirical antibiotics are recommended for children and adults with severe disease, for older adults, for malnourished or chronically ill patients, and to reduce spread (e.g., in institutions).

• #46 Shigella infection – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1174

  Shigella infection is easily spread by fecal-oral contact or by contaminated water or food. It usually presents as a mild, self-limited diarrheal illness. […] Treatment is usually supportive in mild cases, although antibiotics may be useful to shorten the course of the illness and reduce shedding of the organism in stool, particularly in patients with bloody diarrhea. […] Empiric antibiotics are recommended for children and adults with severe disease, for older adults, for malnourished or chronically ill patients, and to reduce spread (e.g., in institutions).

• #47 Shigellosis – Wikipedia

  https://en.wikipedia.org/wiki/Shigellosis

  Treatment consists mainly of replacing fluids and salts lost because of diarrhea. Replacement by mouth is satisfactory for most people, but some may need to receive fluids intravenously. Antidiarrheal drugs (such as diphenoxylate or loperamide) may prolong the infection and should not be used. […] Antibiotics should only be used in severe cases or for certain populations with mild symptoms (elderly, immunocompromised, food service industry workers, child care workers). For Shigella-associated diarrhea, antibiotics shorten the length of infection, but they are usually avoided in mild cases because many Shigella strains are becoming resistant to common antibiotics. […] In most cases, the disease resolves within four to eight days without antibiotics. Severe infections may last three to six weeks. Antibiotics, such as trimethoprim-sulfamethoxazole, ciprofloxacin may be given when the person is very young or very old, when the disease is severe, or when the risk of the infection spreading to other people is high. Additionally, ampicillin (but not amoxicillin) was effective in treating this disease previously, but now the first choice of drug is pivmecillinam.

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