Bacillary dysentery is intestinal infection by Enterobacteriaceae family that causes severe diarrhea, usually characterized by mucus or blood in the faeces.
Medications:
- Tab. Fynal 500 (Levofloxacin 500 mg) 1 tablet twice a day for 5 days
- For abdominal pain – tab. Cyclopam (Dicyclomine 20 mg, paracetamol 500 mg) 1 tablet thrice a day for 3 days
- In severe cases – inj. Monocef 1g (Ceftriaxone 1 gm) 1-2 gm i.v. once a day for 5 days
Patients with bacterial dysentery are at a high risk of dehydration. Please assess patients for level of dehydration and treat as below:
No obvious dehydration
- Patient can be treated at home with ORS (oral rehydration solution). Give as much fluid as patient can tolerate. Patient should continue to eat soft bland diet.
- Ages less than 2 yrs – give 500 ml or more ORS + 50 – 100 ml ORS for every extra stool passed.
- Age 2 to 10 yrs – give 1000 ml or more ORS + 100 – 200 ml ORS for every extra stool passed.
- Age more than 10 yrs – give 2000 ml or more ORS + 100 – 200 ml ORS for every extra stool passed.
Mild to moderate dehydration
- Give as much fluid as patient wants. Patient should continue to eat soft diet.
- Patient weighing less than 6 kg – less than 400 ml ORS
- Patient weighing 6 kg to 10 kg – 400 to 700 ml ORS
- Patient weighing 10 kg to 12 kg – 700 to 900 ml ORS
- Patient weighing 12 kg to 19 kg – 900 to 1400 ml ORS
Reassess dehydration after 4 hours and treat symptoms as suggested above.
Severe dehydration
For ages less than 12 months – give i.v. fluids as suggested below
- First hour – 30 ml/kg of 0.9% Sodium chloride
- Next 5 hours – 70 ml/kg of 0.9% Sodium chloride
- Correct any electrolyte abnormality as needed
- Give ORS if patient can tolerate oral fluids
- Repeat same again if patient condition doesn’t improve.
Age more than 12 months less than 5 years – give i.v. fluids as below
- First 30 minutes – 30 ml/kg of 0.9% Sodium chloride
- Over next 2 & 1/2 hours – 70 ml/kg of 0.9% Sodium chloride
- Correct any electrolyte abnormality as needed.
- Give ORS if patient can tolerate oral fluids
- Repeat same again if patient condition doesn’t improve
Types of enteral infections based on signs and symptoms
- Viral infection – If diarrhea presents with vomiting, low grade fever with no mucus in stool.
- Bacterial infection – If diarrhea presents with vomiting, abdominal cramps, blood and mucus in stools with fever.
- Amoebiasis – If diarrhea presents with blood and mucus in stool with no fever.
- Cholera – If profuse diarrhea presents (rice water stools) with vomiting.
- Food poisoning – If diarrhea present with excessive vomiting; especially if it affects more than one member of the household or group.
Investigations:
- Faecal leukocytes – suggests infective diarrhoea.
- Stool routine – to rule out amoebic cysts.
- Complete Blood Count – to look for systemic infection.
Referral:
- Consider referral to gastroenterologist in case of severe symptoms or if patient presents with complications.
- Patient may need further transfer to secondary care in severe cases.