Shigellosis: The Daily PANCE Blueprint
A 25-year-old man presents to the clinic with a 2-day history of fever, abdominal cramps, and bloody diarrhea. He reports attending a large family picnic 3 days ago. On examination, he is febrile with a temperature of 38.5°C (101.3°F) and has mild abdominal tenderness without rebound or guarding. Stool cultures are pending. Which of the following is the most appropriate initial management for this patient's condition?
A. Start intravenous ciprofloxacin immediately
B. Administer oral rehydration solution and observe
C. Prescribe oral metronidazole
D. Initiate oral azithromycin
E. Immediate colonoscopy to confirm diagnosis
Answer and topic summary
The answer is B. Administer oral rehydration solution and observe
The most appropriate initial management for a patient presenting with symptoms suggestive of shigellosis, especially in the context of a recent potential exposure event like a picnic, is supportive care with oral rehydration solution. This approach addresses the risk of dehydration from diarrhea and is generally sufficient for mild to moderate cases. Antibiotics may be considered in more severe cases, but initial management focuses on rehydration and symptomatic relief.
| Antibiotic |
Preferred Use |
Notes |
| Fluoroquinolones (e.g., Ciprofloxacin) |
Adults |
Effective but may be limited by resistance in some regions. Not recommended for children. |
| Azithromycin |
Children and adults |
Useful especially in areas with fluoroquinolone resistance. Good choice for children. |
| Ceftriaxone |
Severe cases or when oral administration is not feasible |
Injectable option for severe infections or when oral therapy is not possible. |
| Trimethoprim-Sulfamethoxazole (TMP-SMX) |
Alternative option, depending on local resistance patterns |
High resistance rates in many areas limit its use. Should be guided by susceptibility testing. |
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