Treatments for Shigellosis
Shigellosis: Is the Diagnosis Correct?
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Differential diagnosis list for Shigellosis may include:
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Drugs and Medications used to treat Shigellosis:
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Some of the different medications used in the treatment of Shigellosis include:
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Hospital statistics for Shigellosis:
These medical statistics relate to hospitals, hospitalization and Shigellosis:
- 0.0006% (74) of hospital consultant episodes were for shigellosis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 82% of hospital consultant episodes for shigellosis required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 49% of hospital consultant episodes for shigellosis were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 51% of hospital consultant episodes for shigellosis were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
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Hospitals & Medical Clinics: Shigellosis
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Discussion of treatments for Shigellosis:
Shigellosis can usually be treated
with antibiotics. The antibiotics commonly used for treatment
are ampicillin, trimethoprim/sulfamethoxazole (also known as Bactrim*
or Septra*), nalidixic acid, or ciprofloxacin. Appropriate treatment
kills the
Shigella bacteria that might be present in the
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 such as loperamide (Imodium*)
or diphenoxylate with atropine (Lomotil*) are likely to make the
illness worse and should be avoided. (Source: excerpt from
Shigellosis (General): DBMD)
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Book Excerpts: Treatment of Shigellosis
Treatments of Shigellosis: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the treatments of Shigellosis.
Diarrhea - Acute:
Treatment
(In a Page: Signs and Symptoms)
-
Treatment is generally supportive
-
Fluid resuscitation (oral, if possible, or IV)
-
Antimotility agents: Opiates (e.g., loperamide) and parasympathetic inhibitors (e.g., diphenoxylate plus atropine); former concerns that these agents may slow the clearance of pathogens have been disproved
- Antibiotic therapy is reserved for severe disease
–Most authorities recommend empiric treatment with a fluoroquinolone or trimethoprin-sulfamethoxasole in patients with severe or bloody diarrhea, fever, or fecal leukocytes
–If Giardia, C. difficile, or E. histolytica is suspected, treat empirically with metronidazole
–Antibiotic therapy increases the risk of hemolytic-uremic syndrome in children with E. coli O157:H7
–There is no good evidence that antibiotics prolong the carrier state in Salmonella infections
- Advise patient to hydrate with glucose-containing, caffeine-free beverages, and to avoid lactose, sorbitol-containing gum, and raw fruit until symptoms subside
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Diarrhea - Chronic:
Treatment
(In a Page: Signs and Symptoms)
-
Fluid resuscitation: Oral, if possible, or IV (e.g., normal saline or lactated Ringer's)
-
Nonspecific antidiarrheal agents (e.g., loperamide, codeine, tincture of opium) and fiber supplementation may be attempted initially
-
Diabetic neuropathy: Control blood sugar, metoclopramide may be used
-
Irritable bowel syndrome: High-fiber diet, anticholinergics
-
Inflammatory bowel disease is treated with steroids for acute exacerbations and daily prophylactic therapy with 5-aminosalicyclic agents
–Bowel resection may be necessary
-
Lactose intolerance: Lactose-free diet
-
Diseases of malabsorption: Gluten-free diet, long-term antibiotics
-
Intestinal neoplasm: Consultation with gastroenterology, oncology, and/or surgery
>
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Diarrhea – Chronic, No Blood or Weight Loss:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Treatment is directed at cause
-
Chronic nonspecific diarrhea
–Restriction of fluid intake to <90 mL/kg/day
–Reduction of fruit juices (<8 ounces/day)
–Elimination of sorbitol-containing juices
-
Carbohydrate malabsorption
–Trial elimination or reduction of offending sugar
–Lactase (Lactaid) for lactose intolerance
–Sucrase (Sucraid) for sucrase-isomaltase deficiency
-
Small intestine bacterial overgrowth
–Antibiotic therapy with metronidazole alone or in combination with ampicillin or Bactrim
–Surgery for partial small bowel obstruction
-
Low-fat diet: Increase fat intake to approximately 40% of total daily calorie intake
-
Irritable bowel syndrome
–Anticholinergic therapy or antidepressants
-
Acrodermatitis enteropathica: Zinc supplements
>>>>> >>
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Diarrhea – Chronic, with Weight Loss:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Correct malnourished states
-
IBD: Anti-inflammatories (e.g., steroids, 6MP, 5ASA)
-
CD: Lifelong gluten-free diet
-
CF: Pancreatic enzyme and nutritional supplements including fat-soluble vitamins (ADEK)
-
Allergy: Food antigen avoidance
-
Sucrase-isomaltase deficiency: “Sucraid” enzyme
-
Neural crest tumors: Surgical resections
-
VIPoma: Somatostatin
-
Gastrinoma: Proton pump inhibitors
-
Whipple disease: Trimethoprim-sulfamethoxazole
-
Abetalipoprotenemia: No specific treatment
–Supplements of fat-soluble vitamins and MCT oil
-
Acrodermatitis enteropathica: Zinc supplements
-
Giardiasis: Metronidazole or nitazoxamide
-
Hyperalimentation: Parenteral nutrition may be needed for familial enteropathies
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Diarrhea – Acute:
Treatment
(In A Page: Pediatric Signs and Symptoms)
- Mainstay of treatment is rehydration to correct fluid and electrolyte deficits
–Oral route is best in mildly to moderately dehydrated
children who can tolerate PO fluid
–IV fluids: Useful in severe to moderate dehydration
–Estimate fluid deficit using % of weight loss, and add
this to maintenance requirement and ongoing losses
– Correct over 24–48 hours
-
Antibiotics
–Not necessary in most cases, can precipitate HUS
–Indicated for V. cholerae, Shigella, and G. lamblia
–Indicated in selected circumstances: Salmonella in very young infant, if febrile, or positive blood culture
–Metronidazole for C. difficile (if antibiotic elimination doesn’t help)
-
Refeeding: No benefit to withholding milk, incidence of lactose intolerance overstated
-
Probiotics: Lactobacillus rhamnosus for rotavirus
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Shigellosis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment of shigellosis includes enteric precautions, low-residue diet and, most important, replacement of fluids and electrolytes with I.V. infusions of normal saline solution (with electrolytes) in sufficient quantities to maintain a urine output of 40 to 50 ml/hour. Antibiotics are of questionable value but may be used in an attempt to eliminate the pathogen and thereby prevent further spread. Ampicillin, tetracycline, or co-trimoxazole may be useful in severe cases, especially in children with overwhelming fluid and electrolyte loss. Sulfamethoxazole-trimethoprim and ciprofloxacin are also used.
Antidiarrheals that slow intestinal motility are contraindicated in shigellosis because they delay fecal excretion of Shigella and prolong fever and diarrhea. An investigational vaccine containing attenuated strains of Shigella appears promising in preventing shigellosis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Poisonous snakebite:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Patient positioned lying down, with bitten limb placed lower than heart; surgical debridement; antivenin; I.V. fluids; blood products; endotracheal intubation and mechanical ventilation; analgesics
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Poisonous snakebites:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Prompt, appropriate first aid can reduce venom absorption and prevent severe symptoms.
❑ If possible, identify the snake, but don’t waste time trying to find it.
❑ Place the victim in the supine position to slow venom metabolism and absorption.
❑ Don’t give the victim any food, beverage, or medication orally.
❑ Authorities disagree about what constitutes appropriate prehospital care. Some recommend against placing a constrictive tourniquet (band) on the affected limb unless the victim is far from a medical facility.
❑ Whether you apply a tourniquet or not, immediately immobilize the victim’s affected limb below heart level, and instruct the victim to remain as quiet as possible.
❑ If a tourniquet is applied, the victim or the person applying the tourniquet should check the victim’s distal pulses regularly and loosen the tourniquet slightly as needed to maintain circulation. Remember that the goal of applying a tourniquet is to obstruct lymphatic drainage, not blood flow.
❑ When indicated, apply the tourniquet so that it’s slightly constrictive, obstructing only lymphatic and superficial venous blood flow. Apply the band about 4(10 cm) above the fang marks or just above the first joint proximal to the bite. The tourniquet should be loose enough to allow a finger between the band and the skin. After the tourniquet is in place, don’t remove it until a physician has examined the victim.
Alert Don’t apply a tourniquet if more than 30 minutes have elapsed since the bite. Keep in mind also that total tourniquet time shouldn’t exceed 2 hours and that the use of a tourniquet shouldn’t delay antivenin administration. Loss of a limb is possible if a tourniquet is too tight or if tourniquet time is too long.
❑ If the patient is more than a few hours away from a hospital, wash the skin over the fang marks. Within 5 to 15 minutes of a pit viper bite, make an incision through the fang marks about ½"(1.3 cm) long and ⅛"(3.2 mm) deep. Be especially careful if the bite is on the hand, where blood vessels and tendons are close to the skin surface.
Using a bulb syringe — or, if no other means is available, mouth suction — apply suction for up to 1 hour in the absence of antivenin administration.
Alert Remember, an incision and suction are effective only in pit viper bites and only within 1 hour of the bite. Suction is also indicated if transport time to an emergency facility would exceed 30 minutes. Mouth suction is contraindicated if the rescuer has oral ulcers, if the victim is close to a medical facility, or if antivenin can be given promptly.
Alert Never give the victim alcoholic drinks or stimulants because they speed venom absorption. Never apply ice to a snakebite because it will increase tissue damage.
❑ Record the signs and symptoms of progressive envenomation and when they develop. Most snakebite victims are hospitalized for only 24 to 48 hours. Treatment usually consists of antivenin administration, but minor snakebites may not require antivenin. Other treatments include tetanus toxoid or tetanus immune globulin; various broad-spectrum antibiotics; and, depending on respiratory status, severity of pain, and the type of snakebite, acetaminophen, codeine, morphine, or meperidine. (Opioids are contraindicated for the treatment of coral snakebites.)
Necrotic snakebites usually need surgical debridement after 3 or 4 days. Intense, rapidly progressive edema requires fasciotomy within 2 or 3 hours of the bite; extreme envenomation may require amputation of the limb and subsequent reconstructive surgery, rehabilitation, and physical therapy.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Poisoning:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Depending on poison: airway management, CPR, poison antidote, patient placed on left side, supportive care (I.V. fluid replacement, oxygen therapy, seizure precautions)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Diarrhea:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient’s diarrhea is profuse, check for signs of shock—tachycardia, hypotension, and cool, pale, clammy skin. If you detect these signs, place the patient in the supine position and elevate his legs 20 degrees. Insert an I.V. line for fluid replacement. Monitor the patient for electrolyte imbalances, and look for an irregular pulse, muscle weakness, anorexia, and nausea and vomiting. Keep emergency resuscitation equipment handy.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Snakebites, poisonous:
Treatment
(Handbook of Diseases)
Prompt, appropriate first aid can reduce venom absorption and prevent severe symptoms.
❑ If possible, identify the snake, but don’t waste time trying to find it.
❑ Place the victim in the supine position to slow venom metabolism and absorption.
❑ Don’t give the victim any food, beverage, or medication orally.
❑ Authorities disagree about what constitutes appropriate prehospital care. Some recommend against placing a constrictive tourniquet (band) on the affected limb unless the victim is far from a medical facility.
❑ Whether you apply a tourniquet or not, immediately immobilize the victim’s affected limb below heart level, and instruct the victim to remain as quiet as possible.
❑ If a tourniquet is applied, the victim or the person applying the tourniquet should check the victim’s distal pulses regularly and loosen the tourniquet slightly as needed to maintain circulation.
CLINICAL TIP: Remember that the goal of applying a tourniquet is to obstruct lymphatic drainage, not blood flow. The use of a tourniquet in prehospital care is controversial.
❑ When indicated, apply the tourniquet so that it’s slightly constrictive, obstructing only lymphatic and superficial venous blood flow. Apply the band about 4" (10 cm) above the fang marks or just above the first joint proximal to the bite. The tourniquet should be loose enough to allow a finger between the band and the skin. After the tourniquet is in place, don’t remove it until the victim is examined by a physician.
Caution: Don’t apply a tourniquet if more than 30 minutes has elapsed since the bite. Keep in mind also that total tourniquet time shouldn’t exceed 2 hours and that the use of a tourniquet shouldn’t delay antivenin administration. Remember: Loss of a limb is possible if a tourniquet is too tight or if tourniquet time is too long.
❑ If the patient is more than 30 minutes away from a facility, wash the skin over the fang marks. Within 1 hour of a pit viper bite, make an incision through the fang marks about ½" (1.3 cm) long and ⅛" (0.3 cm) deep. Be especially careful if the bite is on the hand, where blood vessels and tendons are close to the skin surface.
Using a bulb syringe — or, if no other means is available, mouth suction — apply suction for up to 2 hours in the absence of antivenin administration.
Remember: An incision and suction are effective only in pit viper bites and only within 1 hour of the bite and if transport time to an emergency facility would exceed 30 minutes. Mouth suction is contraindicated if the rescuer has oral ulcers, if the victim is close to a medical facility, or if antivenin can be given promptly.
❑ Never give the victim alcoholic drinks or stimulants because they speed venom absorption. Never apply ice to a snakebite because it will increase tissue damage.
❑ Record the signs and symptoms of progressive envenomation and when they develop. Most snakebite victims are hospitalized for only 24 to 48 hours. Treatment usually consists of antivenin administration, but minor snakebites may not require antivenin. Other treatments include tetanus toxoid or tetanus immune globulin; various broad-spectrum antibiotics; and, depending on respiratory status, severity of pain, and the type of snakebite, acetaminophen, codeine, morphine, or meperidine. (Opioids are contraindicated in coral snakebites.)
Necrotic snakebites usually need surgical debridement after 3 to 4 days. Intense, rapidly progressive edema requires fasciotomy within 2 to 3 hours of the bite; extreme envenomation may require amputation of the limb and subsequent reconstructive surgery, rehabilitation, and physical therapy.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Diarrhea:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Administer an analgesic for pain and an opioid to decrease intestinal motility, unless the patient has a possible or confirmed stool infection. Ensure the patient’s privacy during defecation, and empty bedpans promptly. Clean the perineum thoroughly, and apply ointment to prevent skin breakdown.
ALERT: Excessive diarrhea may cause skin breakdown and excoriation. To decrease excoriation and facilitate drainage measurement, insert a rectal tube or large indwelling catheter.
Help the patient maintain adequate hydration, administering I.V. fluid replacements. Measure liquid stools, and weigh the patient daily. Monitor electrolyte levels and hematocrit.
Quantify the amount of liquid stool and carefully observe intake and output.
Patient teaching
Explain the purpose of diagnostic tests to the patient. These tests may include blood studies, stool cultures, X-rays, and endoscopy.
Advise the patient to avoid spicy or high-fiber foods (such as fruits), caffeine, high-fat foods, and milk. Suggest smaller, more frequent meals if he has had GI surgery or disease. If appropriate, teach the patient stress-reducing exercises, such as guided imagery and deep-breathing techniques, or recommend counseling.
Stress the need for medical follow-up to patients with inflammatory bowel disease (particularly ulcerative colitis), who have an increased risk of developing colon cancer.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Diarrhea:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient’s diarrhea is profuse, check for signs of shock, including tachycardia, hypotension, and cool, pale, clammy skin. If you detect these signs, place the patient in the supine position and elevate his legs 20 degrees. Insert an I.V. line for fluid replacement. Monitor patient for electrolyte imbalances, and look for an irregular pulse, muscle weakness, anorexia, and nausea and vomiting. Keep emergency resuscitation equipment handy.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Diarrhea:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Administer an analgesic for pain and an opiate to decrease intestinal motility, unless the patient has a possible or confirmed stool infection.
▪ Ensure the patient's privacy during defecation, and empty bedpans promptly.
▪ Clean the perineum thoroughly, and apply ointment to prevent skin breakdown.
▪ Note the amount and characteristics of the patient's stool.
▪ Monitor intake and output.
▪ Obtain serum samples for electrolytes and treat imbalances.
▪ Provide fluid replacement orally or I.V., as appropriate.
Patient teaching
▪ Stress the need for medical follow-up to patients with inflammatory bowel disease (particularly ulcerative colitis) who have an increased risk of developing colon cancer.
▪ Emphasize the importance of maintaining adequate hydration.
▪ Explain food or fluids that should be avoided.
▪ Discuss stress reduction techniques.
▪ Explain the diagnosis and treatment plan.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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