Although severe dehydration is rare with shigellosis, correction of fluid and electrolyte losses, preferably by oral rehydration solutions, is the mainstay of treatment.
Most clinical infections with S. sonnei are self-limited (48 to 72 hours), and mild episodes do not require antimicrobial therapy.
Antimicrobial treatment is recommended for patients with severe disease or with underlying immunosuppressive conditions; in these patients, empiric therapy should be given while awaiting culture and susceptibility results. Available evidence suggests that antimicrobial therapy is somewhat effective in shortening duration of diarrhea and hastening eradication of organisms from feces; however, whether antimicrobial treatment reduces shigellosis transmission is unclear.
Antimicrobial susceptibility testing of clinical isolates is indicated, because resistance to antimicrobial agents is common and may be increasing and because susceptibility data can guide appropriate therapy.
For cases in which treatment is required and susceptibilities are unknown or an ampicillin- and trimethoprim-sulfamethoxazole-resistant strain is isolated, parenteral ceftriaxone for 2 to 5 days, a fluoroquinolone (eg, ciprofloxacin) for 3 days, or azithromycin for 3 days should be administered. . For susceptible strains, oral trimethoprim-sulfamethoxazole for 5 days is effective; amoxicillin is not effective because of its rapid absorption from the gastrointestinal tract. The oral route of therapy is recommended, except for seriously ill patients
