From the Guidelines
For Shiga toxin-positive diarrhea, antimicrobial therapy should be avoided, especially for STEC O157 and other STEC that produce Shiga toxin 2, as it may increase the risk of hemolytic uremic syndrome (HUS) 1. The primary focus should be on supportive care, including maintaining proper hydration by drinking plenty of fluids, such as water, clear broths, and oral rehydration solutions.
- Avoid caffeine and alcohol, as they can exacerbate dehydration.
- Rest and eat small, light meals as tolerated.
- Over-the-counter anti-diarrheal medications like loperamide should be avoided, as they can prolong the infection and potentially increase the risk of complications.
- If symptoms worsen, or if there's blood in the stool, or if dehydration occurs (signs include decreased urination, dry mouth, and dizziness), seek immediate medical attention. It's essential to note that the use of antimicrobial agents, such as fluoroquinolones or azithromycin, may be considered in specific cases, such as severe illness or immunocompromised individuals, but this should be done with caution and under the guidance of a healthcare professional, as the risk of HUS and other complications must be carefully weighed against the potential benefits of treatment 1.
From the FDA Drug Label
Infectious Diarrhea caused by Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, Shigella boydii†, Shigella dysenteriae, Shigella flexneri or Shigella sonnei† when antibacterial therapy is indicated.
The treatment for Shiga toxin-positive diarrhea is ciprofloxacin (PO), as it is indicated for the treatment of infectious diarrhea caused by Shigella species, which can produce Shiga toxin 2.
- Key points:
- Ciprofloxacin is effective against Shigella species
- Shigella species can cause Shiga toxin-positive diarrhea
- Ciprofloxacin is indicated for infectious diarrhea when antibacterial therapy is indicated
From the Research
Treatment for Shiga Toxin-Positive Diarrhea
The treatment for Shiga toxin-positive diarrhea typically involves supportive care and antibiotic therapy.
- Supportive care includes oral rehydration therapy to replace lost fluids and electrolytes 3, 4.
- Antibiotic therapy is beneficial in the treatment of severe diarrhea caused by Shigella, and various antibiotics have been shown to be effective, including:
- Cefixime: a 2-day or 5-day course of cefixime has been shown to be effective in treating shigellosis in children 5.
- Azithromycin: a single-dose or 5-day course of azithromycin has been shown to be effective in treating Shigella infection in non-human primates 6.
- Enrofloxacin: a 7-day course of enrofloxacin has been shown to be effective in treating Shigella infection in non-human primates 6.
- Ceftiofur crystalline free acid (CCFA): a single-dose of CCFA has been shown to be effective in treating Shigella infection in non-human primates 6.
Important Considerations
- The choice of antibiotic and duration of treatment may depend on the severity of the illness, the age and health status of the patient, and the susceptibility of the Shigella strain to the antibiotic.
- Antibiotic treatment has been shown to be associated with a positive outcome in children with Shigella diarrhea 7.
- Oral rehydration therapy is an essential part of the treatment for Shiga toxin-positive diarrhea, and it is recommended to use a standard oral replacement solution, such as the one recommended by the World Health Organization 3.