From the Guidelines
Antibiotics are not generally recommended for infectious enterocolitis in an otherwise healthy young male, unless specific criteria are met, such as severe symptoms, bloody diarrhea, or confirmation of certain bacterial pathogens. Most cases of infectious diarrhea are viral or self-limiting bacterial infections that resolve within 3-5 days with supportive care alone, as noted in the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1. The focus should be on hydration with oral rehydration solutions or clear fluids, rest, and a bland diet as tolerated. Fever control can be achieved with acetaminophen (650mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours).
Key Considerations
- The majority of diarrheal illnesses are self-limited and identification of the infectious etiology often has little value to individual patients, as stated in the guidelines 1.
- Restricting testing to patients with bloody stools, fever, or abdominal tenderness can increase the likelihood of identifying a bacterial pathogen 1.
- Certain bacterial infections, such as Shigella, Campylobacter, or Salmonella, may require antibiotic treatment, especially if symptoms are severe or systemic 1.
Antibiotic Use
- Antibiotics may be warranted in specific situations, such as severe symptoms (high fever >102°F, bloody diarrhea), or if testing confirms certain bacterial pathogens 1.
- Ciprofloxacin 500mg twice daily for 3-5 days or azithromycin 500mg on day 1 followed by 250mg daily for 4 more days may be appropriate in these cases.
- Antibiotics are generally avoided because they can prolong carrier states of some pathogens, disrupt gut microbiota, and may increase the risk of hemolytic uremic syndrome in E. coli O157:H7 infections, as well as contribute to antibiotic resistance 1.
When to Seek Medical Attention
- Medical attention should be sought if symptoms worsen, dehydration develops, or blood appears in the stool.
- Immunocompromised individuals are more likely to experience severe or prolonged illness and may require closer monitoring and more aggressive treatment 1.
From the FDA Drug Label
Infectious Diarrhea caused by Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, Shigella boydii†, Shigella dysenteriae, Shigella flexneri or Shigella sonnei† when antibacterial therapy is indicated.
The patient has infectious enterocolitis with fever, which can be considered as infectious diarrhea. According to the drug label, ciprofloxacin is indicated for the treatment of infectious diarrhea caused by susceptible strains of microorganisms, including some of the common causes of enterocolitis. Antibiotics may be necessary for the treatment of infectious enterocolitis with fever in an otherwise healthy young male, depending on the suspected or confirmed causative organism. 2
From the Research
Treatment of Infectious Enterocolitis
The treatment of infectious enterocolitis with fever in otherwise healthy young males may involve antibiotics, depending on the cause and severity of the infection.
- The use of azithromycin has been studied as a potential treatment option for bacterial enteritis, with results showing that it may be a good empirical therapeutic option 3.
- However, the decision to use antibiotics should be based on the severity of symptoms and the suspected cause of the infection 4, 5.
- In general, antimicrobial therapy is indicated for certain types of infections, such as C. difficile infections, travel-related diarrhea, and other bacterial infections with severe symptoms 4, 6.
Diagnostic Approach
The diagnostic approach to infectious enterocolitis varies with symptom severity, and microbial studies may be necessary for longer-lasting or more severe symptoms 4, 5.
- Multiplex antimicrobial testing is preferred, and stool cultures and microscopic stool examinations are no longer first-line tests 4.
- The establishment of the cause of the infection is crucial for guiding treatment, and tests such as multiplex polymerase chain reaction (PCR) followed by guided culture on PCR-positive pathogens can often confirm active infection 5.
Management
The management of infectious enterocolitis depends on the severity of symptoms, and patients with mild or moderate symptoms can be treated with oral hydration and symptom control measures 4.