Treatment and Monitoring

Although infection with Shigella generally is self-limited and responds to supportive care, antibiotic therapy is indicated because it shortens the duration of illness and shedding and consequently reduces the risk of transmission. Antibiotic resistance is a worldwide concern and growing problem for enteric bacterial pathogens. The treatment of choice is a fluoroquinolone when the antibiotic susceptibility of the organism is unknown5 (Table 76-2). Cephalosporins or azithromycin can be used in the management of pediatric shigellosis. Rifaximin is likely to be effective in the treatment of milder forms of shigellosis and is effective at preventing infection with S. flexneri 6 Antimotility agents are not recommended because they can worsen dysentery and may be related to the development of toxic megacolon. No vaccines are licensed currently for the prevention of shigellosis.

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