Amoebic dysentery is characterized by loose stools due to infection caused by any amoeba from Entamoeba group (through food, water and poor hygiene).
Medications:
- Tab. Flagyl 400 (Metronidazole 400 mg) 1 tablet thrice a day for 7 days.
- Tab. Amicline (Diloxanide Furoate 500 mg) 1 tablet thrice a day for 10 days (as a luminal agent – after above course is completed).
- For abdominal pain – tab. Cyclopam (Dicyclomine hydrochloride 20 mg, paracetamol 500 mg) 1 tablet thrice a day for 3 days
- If stool examination shows pus cells – tab. Levoquin 500 (Levofloxacin 500 mg) 1 tablet twice a day for 5 days.
Patients with amoebic 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 wants and advice 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 from 6 kg to 10 kg – 400 to 700 ml ORS
- Patient weighing from 10 kg to 12 kg – 700 to 900 ml ORS
- Patient weighing from 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 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 clinical 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 tolerates oral fluids
- Repeat same again if patient condition doesn’t improve
Natural remedies:
- Drumstick soup, bel fruit pulp (kawat – Limonia), black tea, garlic can help with the loose motions.
- Meals which are high in potassium such as banana, prunes, raisins and dates.
- The enzyme bromelain in pineapple aids in digestion.
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 present with blood and mucus in stool with no fever.
- Cholera – If profuse diarrhea present (rice water stools) with vomiting
- Food poisoning – If diarrhea present with excessive vomiting; especially if in more than one member of the household or group.
Investigations:
- Stool routine – to look for amoebic cysts
- Faecal leukocytes – suggests infective diarrhoea
- Complete blood count – to look for systemic infection
Referral:
Consider further referral to gastroenterologist or secondary care if patient fails to respond or presents with complications.