What is the treatment for enteritis?

Treatment of Enteritis

The treatment of enteritis should be based on the specific causative pathogen, with most cases requiring supportive care rather than antimicrobial therapy. 1

Diagnostic Approach

Before determining treatment, proper diagnosis is essential:

• Evaluate for specific symptoms: diarrhea, abdominal cramping without signs of proctitis or proctocolitis 1

• Determine likely etiology based on risk factors:

  • Sexual practices including oral-fecal contact (for sexually transmitted enteritis) 1
  • Recent international travel
  • Immunocompromised status
  • Recent antibiotic use (for C. difficile)

• For persistent or severe symptoms, diagnostic workup should include:

  • Stool examination (multiple samples may be necessary for certain pathogens)
  • Special stool preparations for cryptosporidiosis and microsporidiosis if suspected 1
  • Microbiologic tests only if clinically indicated 1

Treatment Algorithm

1. Supportive Care (First-line for most cases)

• Fluid and electrolyte repletion 2
• Symptomatic management
• Bowel rest as needed

2. Antimicrobial Therapy (Based on specific pathogens)

For bacterial enteritis:

• In immunocompetent patients with acute watery diarrhea without recent international travel, empiric antimicrobial therapy is NOT recommended 1
• Exceptions for empiric therapy:
  • Immunocompromised patients
  • Young infants who appear ill
  • Patients with fever documented in a medical setting, abdominal pain, and bloody diarrhea 1

For specific pathogens:

• Giardia lamblia (most common in otherwise healthy persons):

  • Requires specific antiparasitic treatment

• Clostridioides difficile:

  • Requires specific antimicrobial therapy 1

• For sexually transmitted enteritis:

  • Treat according to identified pathogen
  • Sex partners should be evaluated for diseases diagnosed in the patient 1

3. Special Populations

Immunocompromised patients:

• More aggressive diagnostic workup and treatment may be needed
• Consider pathogens not typically sexually transmitted:
  • CMV
  • Mycobacterium avium-intracellulare
  • Salmonella
  • Campylobacter
  • Cryptosporidium
  • Microsporidium
  • Isospora 1

Radiation enteritis:

• Nutritional therapy following same criteria as for other causes of chronic intestinal failure
• Try enteral nutrition if oral nutrition is inadequate
• Home parenteral nutrition should not be delayed in malnourished patients if oral/enteral nutrition is inadequate 1

Important Considerations

• Do not use antimicrobial therapy for STEC O157 and other STEC that produce Shiga toxin 2 as it may increase risk of hemolytic uremic syndrome 1

• Persistent symptoms (>14 days) without identified source should prompt consideration of non-infectious conditions like IBD and IBS 1

• For patients who don't respond to initial therapy, clinical and laboratory reevaluation may be necessary 1

• Asymptomatic contacts of people with enteritis should not receive empiric or preventive therapy 1

By following this approach and targeting therapy to the specific pathogen when identified, most cases of enteritis can be effectively managed with good outcomes.