Antibiotic Treatment for Bacterial Dysentery
Azithromycin is the preferred first-line antibiotic for bacterial dysentery, with a recommended dosage of 1000 mg as a single dose or 500 mg daily for 3 days. 1, 2, 3
First-Line Treatment
- Azithromycin is superior for bacterial dysentery due to its effectiveness against common causative pathogens including Shigella, Campylobacter, and invasive E. coli 1, 3
- For severe dysentery: Single 1-gram dose or 500 mg daily for 3 days 4, 1
- Single-dose regimens are effective and improve patient compliance while reducing antimicrobial resistance risk 4, 1
- Azithromycin demonstrates 100% clinical and bacteriological cure rates for dysentery, particularly for Campylobacter infections 2, 5
Alternative Treatment Options
- Fluoroquinolones (ciprofloxacin 750 mg single dose or 500 mg twice daily for 3 days) may be used for non-dysenteric diarrhea in areas without high resistance 4, 1
- However, fluoroquinolone resistance exceeds 85-90% for Campylobacter in Southeast Asia and is increasing globally, making azithromycin clearly superior 1, 5
- Rifaximin (200 mg three times daily for 3 days) should NOT be used for dysentery as it is only effective for non-invasive watery diarrhea 4, 1
Special Considerations
- For severe cases with inability to tolerate oral medications, IV azithromycin can be administered at 500 mg daily for 2-5 days 2
- Ciprofloxacin, ceftriaxone and pivmecillinam are also recommended by WHO for dysentery in children, with cure rates >99% 6
- Loperamide may be used as adjunctive therapy with antibiotics to further reduce gastrointestinal symptoms and illness duration 4, 3
Important Caveats
- Bacterial confirmation should ideally be obtained before treatment, but empiric therapy is warranted in severe cases 2
- Antibiotic treatment significantly reduces symptom severity and duration of illness in bacterial dysentery 3, 7
- There is increasing association between antibiotic use and acquisition of multidrug-resistant bacteria, so antibiotics should be reserved for moderate to severe cases 1
- Regional differences in pathogen prevalence and resistance patterns should guide antibiotic selection 1, 3
Treatment Algorithm
- For confirmed or suspected bacterial dysentery: Azithromycin 1 gram single dose or 500 mg daily for 3 days 4, 1
- For severe cases with inability to take oral medications: IV azithromycin 500 mg daily 2
- In areas with low fluoroquinolone resistance and for non-dysenteric cases: Consider ciprofloxacin 750 mg single dose or 500 mg twice daily for 3 days 4, 1
- Adjunctive therapy with loperamide may be considered to reduce symptoms 4, 3