What is the treatment for infectious enterocolitis (inflammation of the small intestine and colon)?

From the Guidelines

Treatment of infectious enterocolitis primarily involves supportive care with oral rehydration therapy to prevent dehydration, and antibiotics are indicated for specific bacterial causes, such as ciprofloxacin for Shigella or Campylobacter, metronidazole for Clostridium difficile, or azithromycin for traveler's diarrhea, as recommended by recent guidelines 1. The goal of treatment is to manage symptoms, prevent dehydration, and address the underlying infection.

• Supportive care includes oral rehydration therapy with clear fluids containing electrolytes, such as sports drinks or oral rehydration solutions like Pedialyte.
• For severe dehydration, intravenous fluids may be necessary.
• Most cases resolve without antibiotics, as many are viral in nature.
• However, antibiotics are indicated for specific bacterial causes, such as:

• Ciprofloxacin 500mg twice daily for 3-5 days for Shigella or Campylobacter.
• Metronidazole 500mg three times daily for 10-14 days for Clostridium difficile, as suggested by the european society of clinical microbiology and infectious diseases (escmid) 1.
• Azithromycin 500mg once daily for 3 days for traveler's diarrhea.

• Probiotics such as Lactobacillus or Saccharomyces boulardii may help restore gut flora.
• Antimotility agents like loperamide (Imodium) 4mg initially then 2mg after each loose stool (maximum 16mg/day) can provide symptomatic relief but should be avoided in bloody diarrhea or suspected inflammatory conditions.
• Dietary modifications include avoiding dairy, fatty foods, and high-fiber items during acute illness, then gradually reintroducing normal foods as symptoms improve. In cases of neutropaenic enterocolitis, broad-spectrum antibiotics, granulocyte colony-stimulating factors (G-CSFs), nasogastric decompression, i.v. fluids, bowel rest, and serial abdominal examinations are recommended, with surgical intervention considered in selected patients 1. The choice of antibiotics should cover enteric gram-negative organisms, gram-positive organisms, and anaerobes, with reasonable initial choices including monotherapy with piperacillin-tazobactam or imipenem-cilastatin, or combination therapy with cefepime or ceftazidime along with metronidazole 1.

From the FDA Drug Label

Vancomycin Hydrochloride Capsules are indicated for the treatment of C. difficile-associated diarrhea. Vancomycin Hydrochloride Capsules are also used for the treatment of enterocolitis caused by Staphylococcus aureus (including methicillin-resistant strains) in adult and pediatric patients less than 18 years of age

Staphylococcal enterocolitis: Total daily dosage is 500 mg to 2 g administered orally in 3 or 4 divided doses for 7 to 10 days.

For both C. difficile-associated diarrhea and staphylococcal enterocolitis, the usual daily dosage is 40 mg/kg in 3 or 4 divided doses for 7 to 10 days. The total daily dosage should not exceed 2 g

Infectious Enterocolitis Treatment:

• Vancomycin Hydrochloride Capsules are used to treat enterocolitis caused by Staphylococcus aureus (including methicillin-resistant strains) and C. difficile-associated diarrhea.
• The recommended dose for adults with staphylococcal enterocolitis is 500 mg to 2 g administered orally in 3 or 4 divided doses for 7 to 10 days.
• The recommended dose for pediatric patients (less than 18 years of age) is 40 mg/kg in 3 or 4 divided doses for 7 to 10 days, not exceeding 2 g per day 2.

From the Research

Treatment of Infectious Enterocolitis

• The treatment of infectious enterocolitis depends on the establishment of the cause, with most forms being treatable with antimicrobials 3.
• For empiric treatment of febrile dysenteric diarrhea, invasive bacterial enteropathogens such as Shigella, Salmonella, and Campylobacter should be suspected, and adults may be treated empirically with 1000mg azithromycin in a single dose 4.
• Pathogen-specific antimicrobial therapy should be initiated for all forms of infectious colitis other than Shiga toxin-producing Escherichia coli (STEC) 4.
• Multiplex polymerase chain reaction (PCR) followed by guided culture on PCR-positive pathogens can often confirm active infection, while standard culture methods provide isolates for antibiotic susceptibility testing, subtyping, and Whole Genome Sequencing 3.

Specific Treatments

• For Clostridium difficile infection, treatment is evidence-based and depends on the severity of the infection, with options including oral metronidazole, vancomycin, or fidaxomicin 5.
• For immune checkpoint inhibitor-associated enterocolitis, very low quality evidence suggests that corticosteroids, infliximab, and vedolizumab may be effective for treatment, although large-scale prospective cohort studies and RCTs are needed to develop prophylactic and therapeutic treatments 6.
• Antibiotic therapy plays an invaluable role in the management of patients suffering from severe diarrhea or extraintestinal symptoms due to invasive bacterial pathogens 7.

Diagnostic Approaches

• Standard stool culture should be performed in patients with infectious colitis, and epidemiologic findings may suggest the need for specialized studies of etiology 4.
• A competent laboratory should look for E. coli O157:H7 and Shiga toxin directly in stool when STEC is suspected as a pathogen 4.
• Optimized algorithms for diagnosis, treatment, and hygiene can help lower the incidence, morbidity, and mortality of C. difficile infection 5.