Shigellosis (Bacterial Dysentery)

Plan A (no dehydration): Drink as much ORS solution / fluid as desired after each loose stool. Plan B (some dehydration): 2,200 to 4,000 mL of ORS solution over the first 4 hours (up to 750 mL/hour), then reassess. - Until diarrhoea stops

(Plan B (some dehydration): give the child's weight in kg x 75 mL of ORS solution in the first 4 hours, then reassess. Plan A (no dehydration): 50-100 mL after each loose stool under 2 years, 100-200 mL from 2 to 10 years.)

WHO. The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th rev. Geneva: WHO; 2005 (IRIS 10665/43209), section 4.3.1 and Table 2

Core supportive treatment for bacillary dysentery; fluid and electrolyte replacement is needed whether or not antibiotics are given.

Shigellosis - disease-level clinical article (shigellosis-full.txt)

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

500 mg by mouth every 12 hours. x 3 days

10 mg/kg/dose [child max 500 mg]

(Formulary general paediatric dosing for mild to moderate infection: 10 mg/kg per dose twice daily by mouth (immediate release), maximum 500 mg per dose. The formulary's 15 to 20 mg/kg per dose figure is for severe infection and carries a 750 mg per- dose maximum - do not pair 15 mg/kg with a 500 mg cap. Ciprofloxacin is not first-line in children and the formulary gives no paediatric enteric-infection regimen.)

WATCH group - carries resistance cost. Egyptian EML 2025.

Egyptian National Drug Formulary - Antimicrobial 2023, Ciprofloxacin monograph, PDF page index 373-374 (printed p364-365). The formulary lists "infectious diarrhea" as an adult indication but attaches no dose to it; the 500 mg every 12 hours figure is taken from its nontyphoidal Salmonella GI regimen. There is no shigellosis, campylobacter or Yersinia enterocolitica regimen in this monograph.

A 3-day course of ciprofloxacin is the standard empiric antibiotic for shigellosis presenting as bloody dysentery.

500 mg once daily x 3 days

Formulary general dosing for susceptible infection, oral: 10 to 12 mg/kg as a single dose on day 1 (maximum 500 mg), then 5 to 6 mg/kg once daily (maximum 250 mg) for the rest of the course. The day-1 dose and the maintenance dose are different - do not give 10 mg/kg every day. (The flat 10 mg/kg once daily, max 500 mg, is the formulary's intravenous figure.)

WATCH group - carries resistance cost. Egyptian EML 2025.

Egyptian National Drug Formulary - Antimicrobial 2023, Azithromycin monograph, PDF page index 267-268 (printed p258-259), "General dosing, susceptible infection". Note: this monograph lists no shigellosis or campylobacter indication - the dose shown is the formulary's general azithromycin course, not an indication-matched regimen.

Effective alternative antibiotic for shigellosis, particularly when a fluoroquinolone is undesirable.

1 to 2 g once daily

50-100 mg/kg/day [child max 4000 mg]

(MSF, child 1 month and over and under 50 kg: 50 to 100 mg/kg (maximum 4 g) once daily. The WHO diarrhoea manual gives the shigella course itself: children 50-100 mg/kg once a day IM for 2 to 5 days. Child 50 kg and over is dosed as an adult.)

WATCH group - carries resistance cost. Egyptian EML 2025.

MSF Essential Drugs 2024 (ceftriaxone injectable monograph: "Severe bacterial infections: septicaemia, meningitis, pneumonia, typhoid fever, shigellosis..."), with the paediatric shigella course from WHO. The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th rev. Geneva: WHO; 2005, antimicrobial table, Shigella dysentery

The disease article states that for children the WHO recommends ciprofloxacin, pivmecillinam or ceftriaxone. The card carried ciprofloxacin and azithromycin only - no parenteral option for a child who cannot keep oral therapy down. MSF names shigellosis explicitly in ceftriaxone's own indications, and the WHO diarrhoea manual gives the paediatric shigella course. Pivmecillinam, the third WHO option, is NOT on this card: it has no product at all in the Egyptian register, so the row would have carried no brand a Cairo prescriber could dispense.

No adult dose is stated - the indication is limited to children under 5 years (see paediatric dosing)

(MSF: child under 6 months, 10 mg (half a 20 mg dispersible tablet) once daily for 10 days; child from 6 months to 5 years, 20 mg (one tablet) once daily for 10 days. WHO gives the same range over a slightly longer course: 10-20 mg/day for 10 to 14 days.)

MSF Essential Drugs 2024 (zinc sulfate oral monograph: "Adjunct to oral rehydration therapy in the event of acute and/or persistent diarrhoea in children under 5 years"), corroborated by WHO. The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th rev. Geneva: WHO; 2005

The disease article says zinc supplements should be given to children with watery diarrhoea; the card carried ORS without it. MSF indicates zinc sulfate as an adjunct to oral rehydration therapy in acute or persistent diarrhoea in children under 5 and gives the doses; the WHO diarrhoea manual recommends 10-20 mg/day for 10 to 14 days for all children with diarrhoea. Named Zinc sulphate rather than MSF's Zinc sulfate because that is how the Egyptian register spells it (6 single-ingredient products); same salt.