From the Guidelines
Treatment for enterocolitis should prioritize supportive care, including fluid and electrolyte replacement, and targeted interventions based on the underlying cause, with high-dose systemic glucocorticoids being a first-line treatment for immune checkpoint inhibitor (ICI) colitis, as recommended by the American Gastroenterological Association 1. The management of enterocolitis involves a combination of supportive care and targeted interventions. Initial management focuses on fluid and electrolyte replacement through oral rehydration solutions or intravenous fluids if dehydration is severe.
- Antibiotics may be prescribed for bacterial causes, with choices including ciprofloxacin 500mg twice daily for 5-7 days, metronidazole 500mg three times daily for 7-10 days, or vancomycin 125mg four times daily for 10-14 days for Clostridioides difficile infections.
- Dietary modifications are important, including temporarily avoiding dairy products, high-fiber foods, and fatty foods while maintaining adequate nutrition.
- Anti-diarrheal medications like loperamide should generally be avoided as they can worsen certain types of infectious enterocolitis. For inflammatory causes, such as ICI colitis, high-dose systemic glucocorticoids, given in doses of 0.5–2 mg/kg prednisone equivalent daily with a taper of 4–6 weeks, are the recommended first-line treatment, as stated in the AGA clinical practice update 1. In cases where patients do not respond to glucocorticoids, infliximab and vedolizumab are reasonable options for treatment of glucocorticoid refractory colitis, with infliximab typically dosed at 5 mg/kg given intravenously and vedolizumab given intravenously at a 300-mg dose 1. Severe cases may require hospitalization for intensive monitoring, intravenous antibiotics, and in rare cases, surgical intervention if complications like perforation or toxic megacolon develop. The treatment approach targets both symptom relief and addressing the underlying inflammation or infection in the intestinal lining, allowing the damaged tissue to heal while preventing complications, as outlined in the AGA clinical practice update on diagnosis and management of immune checkpoint inhibitor colitis and hepatitis 1.
From the FDA Drug Label
INTRA‑ABDOMINAL INFECTIONS, including peritonitis, intra‑abdominal abscess, and liver abscess, caused by Bacteroides species including the B. fragilis group (B. fragilis, B. distasonis, B. ovatus, B. thetaiotaomicron, B vulgatus), Clostridium species, Eubacterium species, Peptococcusniger, and Peptostreptococcus species.
The treatment for enterocolitis may involve metronidazole tablets for infections caused by susceptible anaerobic bacteria, such as Bacteroides species and Clostridium species.
- Key points:
- Metronidazole tablets are indicated in the treatment of serious infections caused by susceptible anaerobic bacteria.
- Indicated surgical procedures should be performed in conjunction with metronidazole tablet therapy.
- In a mixed aerobic and anaerobic infection, antimicrobials appropriate for the treatment of the aerobic infection should be used in addition to metronidazole tablets. 2
From the Research
Enterocolitis Treatment Overview
- Enterocolitis treatment depends on the underlying cause of the condition, which can range from infectious colitis to inflammatory bowel disease.
- For infectious colitis, antimicrobials are often used as treatment, with the specific type and duration depending on the causative pathogen 3, 4.
- In cases of inflammatory bowel disease, such as ulcerative colitis, treatment may involve aminosalicylates, corticosteroids, thiopurines, methotrexate, and anti-tumor necrosis factor agents 5, 6.
Treatment Approaches
- For acute infectious colitis, a time-structured approach is recommended, with consideration of the patient's clinical features, work-up, and treatment options 3.
- In patients with ulcerative colitis, mesalamine is considered a first-line therapy, with doses of more than 2.4 g/d achieving higher rates of clinical and endoscopic remission 6.
- For necrotizing enterocolitis, a devastating disease affecting premature neonates, new biomarkers and potential treatments have emerged, offering earlier therapeutic intervention and improved outcomes 7.
Specific Treatment Options
- Antimicrobial therapy should be initiated for all forms of infectious colitis, except for Shiga toxin-producing Escherichia coli (STEC) 4.
- Empiric treatment with azithromycin may be used for febrile dysenteric diarrhea suspected to be caused by invasive bacterial enteropathogens 4.
- Conventional drugs, including aminosalicylates, corticosteroids, and thiopurines, remain the mainstay of therapy for inflammatory bowel diseases, but require optimization of drug type, timing, and context to manage individual patients effectively 5.