From the Guidelines
Treatment for enterocolitis, particularly in the context of immune checkpoint inhibitor (ICI) enterocolitis, typically involves first-line glucocorticoid treatment, with second-line immunosuppressants such as infliximab or vedolizumab for those who do not respond adequately to steroids. The approach to managing enterocolitis can be broken down into several key steps:
- Initial assessment and management: This includes evaluating the severity of the disease using tools like the Mayo Clinic Endoscopic Scoring system 1, which helps in determining the disease activity and guiding the treatment approach.
- First-line treatment: Glucocorticoids are the initial treatment for ICI enterocolitis. However, approximately one-third of patients may not respond adequately to this treatment 1.
- Second-line treatment: For patients who do not respond to high-dose glucocorticoids within 72 hours or do not have a complete response within a week, second-line immunosuppression with agents like infliximab or vedolizumab should be considered 1. The choice between these two agents should be based on factors such as the underlying malignancy, comorbidities, risk of infection, and expected duration of treatment.
- Dosing and administration: Infliximab is typically dosed at 5 mg/kg given intravenously, and vedolizumab is given intravenously at a 300-mg dose, with both infusions typically given at weeks 0,2, and 6 1.
- Monitoring and adjustment: Responses to treatment are typically rapid, but maintenance therapy may still be required for certain cases, and the decision to continue or adjust treatment should be based on the patient's response and underlying conditions 1.
It's crucial to tailor the treatment approach to the individual patient's needs, considering the severity of the enterocolitis, the presence of underlying conditions, and the potential risks and benefits of each treatment option.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Enterocolitis
- The treatment for enterocolitis typically consists of antibiotic therapy and supportive care, with the addition of surgical intervention as necessary 2.
- For necrotizing enterocolitis (NEC), the most common gastrointestinal emergency in newborns, treatment includes antibiotic therapy, such as ampicillin, gentamicin, and metronidazole, and supportive care 2.
- In cases of immune checkpoint inhibitor-induced enterocolitis, treatment options include corticosteroids, infliximab, and vedolizumab, with response rates varying depending on the checkpoint inhibitor regimen and cancer type 3.
- Budesonide has been shown to be effective in treating microscopic colitis, a subset of enterocolitis, and may be a viable alternative to systemic glucocorticoids 4.
- A scoring tool and treatment algorithm for NEC in infants with congenital heart disease (CHD) has been developed, aiming to enhance early diagnosis, categorize disease severity, and expedite safe return to enteral feeding 5.
Antibiotic Regimens
- Various antibiotic regimens have been used to treat NEC, including combinations of ampicillin, gentamicin, and metronidazole, as well as cefotaxime and vancomycin 6.
- However, there is currently no sufficient evidence to recommend a specific antibiotic regimen, route of administration, or duration of treatment for infants with NEC 6.
- The use of antibiotics in the treatment of NEC is crucial, but the optimal regimen and duration of treatment remain unclear, highlighting the need for further research 2, 6.
Supportive Care
- Supportive care, including nil per os (NPO), total parenteral nutrition, and enteral feeding, plays a critical role in the management of enterocolitis 5.
- The implementation of a scoring tool and treatment algorithm for NEC in infants with CHD has been shown to reduce NPO days, antibiotic duration, and time to full feeds without increasing surgical NEC 5.