From the Guidelines
Enterocolitis is diagnosed and treated based on a combination of clinical evaluation, laboratory tests, and imaging studies, with treatment depending on the underlying cause, and the most recent guidelines recommend early diagnosis and treatment to reduce mortality associated with fulminant colitis. Diagnosis typically begins with a thorough medical history and physical examination, followed by blood tests to check for infection markers and stool samples to identify pathogens 1. Imaging studies such as X-rays or CT scans may be used to assess the extent of inflammation, while colonoscopy with biopsy provides definitive diagnosis in certain cases.
Treatment Approach
Treatment depends on the underlying cause but generally includes supportive care with fluid and electrolyte replacement, dietary modifications, and medications. For infectious enterocolitis, specific antibiotics are prescribed based on the identified pathogen. For example, metronidazole (500mg three times daily for 10-14 days) may be used for Clostridium difficile infections, while vancomycin (125mg four times daily for 10 days) is recommended for severe cases 1.
Surgical Intervention
Surgical intervention becomes necessary if complications such as perforation, obstruction, or toxic megacolon develop, and recent guidelines recommend resection of the entire colon or diverting loop ileostomy with colonic lavage as treatment options for fulminant colitis 1. The treatment approach varies based on the severity and cause of enterocolitis, with the goal of reducing inflammation, eliminating infection, restoring fluid balance, and preventing complications.
Recent Guidelines
Recent guidelines from 2019 update the management of Clostridioides (Clostridium) difficile infection in surgical patients, recommending early diagnosis and treatment, and highlighting the importance of surgical intervention in severe cases 1. These guidelines also recommend the use of high-dose vancomycin and intravenous metronidazole in combination with surgical intervention for fulminant colitis.
- Key points to consider in the diagnosis and treatment of enterocolitis include:
- Early diagnosis and treatment to reduce mortality associated with fulminant colitis
- Use of specific antibiotics based on the identified pathogen
- Surgical intervention for complications such as perforation, obstruction, or toxic megacolon
- Recent guidelines recommend resection of the entire colon or diverting loop ileostomy with colonic lavage as treatment options for fulminant colitis
- High-dose vancomycin and intravenous metronidazole in combination with surgical intervention for fulminant colitis 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diagnosis of Enterocolitis
- The diagnosis of enterocolitis, including conditions such as Clostridium difficile infection (CDI) and food protein-induced enterocolitis syndrome (FPIES), relies heavily on clinical presentation and history 2.
- For CDI, diagnosis is often confirmed by a stool toxin test 3, 4, 5.
- In the case of FPIES, oral food challenges remain the gold standard for confirming diagnosis, with a detailed history and physical exam findings also playing a crucial role 2.
- Biomarkers and imaging studies may be suggestive but are not specific for enterocolitis, making diagnosis challenging 6.
Treatment of Enterocolitis
- Treatment for CDI typically involves antibiotic therapy, with vancomycin and fidaxomicin being more effective than metronidazole for achieving symptomatic cure 3, 4, 5.
- Fidaxomicin has been shown to have a lower risk of recurrence compared to vancomycin 3, 4, 5.
- For FPIES, acute management includes IV hydration, anti-emetics, and IV corticosteroids, while prevention strategies involve strict food avoidance until a food reintroduction challenge is deemed appropriate 2.
- Restoration of the intestinal ecosystem, such as through fecal transplant, may be necessary in cases of severe dysmicrobia associated with clostridial colitis 3.
Development of Enterocolitis
- Enterocolitis, including CDI and FPIES, can develop due to various factors such as antibiotic use, food exposure, and intestinal dysmicrobia 3, 2.
- The exact mechanisms underlying the development of enterocolitis are not fully understood and require further research 6, 2.
- Certain foods, such as cow's milk and soy, are common triggers for FPIES, while the use of broad-spectrum antibiotics can disrupt the intestinal microbiota and lead to CDI 3, 2.