Acute Bloody Diarrhoea/Dysentery

Dysentery is diarrhoea presenting with loose frequent stools containing blood. Most episodes are due to Shigella infection and nearly all require antibiotic treatment.

Diagnosis

The diagnostic signs of dysentery are frequent loose stools with visible red blood. Others include: abdominal pain, fever, convulsions, lethargy, dehydration Acute Gastroenteritis, rectal prolapse.

Treatment

Children with severe malnutrition and dysentery, and young infants (<2 months old) with dysentery should be admitted to hospital. In addition children who are toxic, lethargic, have abdominal distension and tenderness or convulsions are at high risk of sepsis and should be hospitalised. Examine for surgical causes of bloody stool - intussusception, rectal prolapse, bowel ischaemia. If there is no dehydration or evidence of sepsis or abdominal pain can be treated at home.

• Give an oral antibiotic
  • Azithromycin 15 mg/kg (maximum 1000 mg) on the first day, then 10 mg/kg (maximum 500 mg) for 4 days (first line).
  • Ciprofloxacin 15 mg/kg per dose (maximum single dose 500 mg) twice daily for 3 days. For children <18 years, ciprofloxacin should be used only if no other safe and effective alternative is available.
• If the patient shows no improvement by 48 hours of therapy with one of these oral agents, consider
  • IV Ceftriaxone 50 mg/kg per day in one dose daily (maximum 2 g/day) for 2-5 days
• The management is otherwise the same as for acute watery diarrhoea
• Fluid rehydration as required
• Give zinc supplements as for children with watery diarrhoea

Follow-up

It is important to ensure that children are followed up to ensure a response to treatment. If there is no improvement after 2 full days of treatment:

• check for other conditions
• stop the first antibiotic, and give a second-line antibiotic

If there is still no improvement, discuss with seniors. If amoebiasis is possible, give metronidazole 10 mg/kg (maximum 750 mg) three times a day for 5 days.