Most people treat stomach infections the way they would a bad cold — rest, wait, and reach for whatever is in the medicine cabinet. With Shigella, that instinct can make things significantly worse. Dr Muhammed Niyas, consultant in infectious diseases at KIMSHEALTH, Thiruvananthapuram, explains to Unnikrishnan S the mistakes patients make and what to do instead. Edited excerpts:
Not every stomach bug needs a doctor. Where does Shigella sit on that scale?
Further along than most people expect. Milder cases can be managed with fluids and rest, but the moment illness turns serious, high fever, bloody stools, signs of dehydration, antibiotics become essential. They are also recommended for anyone with weakened immunity, signs of bloodstream involvement, and food handlers, where public-health stakes are higher. When prescribed appropriately, antibiotics shorten both fever and diarrhoea and reduce how long the patient remains infectious.
Patients often stop their course the moment they feel better. How dangerous is that?
Quite dangerous. Feeling better is not the same as being cleared. Stopping early risks an incomplete cure, prolongs the window during which you can spread the infection, and contributes to antibiotic resistance — already a serious problem with Shigella globally. The course is usually short, around three days, but that decision belongs to the treating doctor, not the patient.
What about anti-diarrhoeal medicines — the kind available at any pharmacy?
Avoid them entirely. Drugs like loperamide slow the gut to suppress diarrhoea, but that is precisely the wrong approach here. Trapping bacteria and toxins inside worsens the illness, extends how long the germ is shed, and can push a manageable infection toward serious complications. Rehydration, not suppression, is the answer.
When should someone stop waiting it out and go straight to the emergency room?
Watch for very high fever, confusion, drowsiness, or seizures — especially in children. Significant dehydration, stools becoming bloodier, and no improvement after three days of treatment all signal that the infection may be spreading beyond the gut and needs immediate hospital assessment.
Once symptoms clear, what does sensible recovery look like?
Eat early, eat adequately, and prioritise protein to recover the weight the illness strips away. Do not rush back to work or school — Shigella can still be shed in stool after symptoms resolve. Food handlers and those working with children should wait at least two days after diarrhoea stops. When you do return, hand hygiene is non-negotiable.