Assessment and Management of Enteritis
The management of enteritis should focus on fluid and electrolyte repletion, symptomatic care, and selective use of antimicrobial therapy based on clinical presentation, with empiric antibiotics reserved for specific high-risk scenarios or evidence of invasive disease. 1
Initial Assessment
Clinical Evaluation
- Determine severity based on:
- Presence of fever, abdominal pain, bloody stools
- Signs of dehydration (dry mucous membranes, decreased skin turgor, tachycardia)
- Hemodynamic status (orthostatic vital signs)
- Duration of symptoms (acute vs. persistent)
- Risk factors (recent travel, antibiotic use, immunocompromised status)
Diagnostic Workup
- Stool studies indicated for:
- Symptoms lasting >7 days
- Bloody diarrhea
- Fever >38.5°C
- Severe abdominal pain
- Immunocompromised patients
- Recent hospitalization or antibiotic use (test for C. difficile)
- Recent travel to endemic areas
Management Algorithm
1. Rehydration Therapy
- First-line treatment for all patients with enteritis 1
- Mild to moderate dehydration:
- Oral rehydration solution (ORS)
- For adults, diluted juice or sports drinks may be acceptable alternatives 2
- Severe dehydration or inability to tolerate oral intake:
- Intravenous isotonic fluids (lactated Ringer's or normal saline)
- Continue until pulse, perfusion, and mental status normalize 1
2. Antimicrobial Therapy
Do not routinely administer antibiotics for uncomplicated enteritis 1
Empiric antibiotics indicated for:
- Infants <3 months with suspected bacterial etiology
- Patients with fever, abdominal pain, bloody diarrhea, and dysentery (presumed Shigella)
- Recent international travel with fever ≥38.5°C or signs of sepsis
- Immunocompromised patients with severe illness
- Suspected enteric fever (after blood, stool, and urine cultures collected) 1
Recommended empiric regimens:
- Adults: Fluoroquinolone (e.g., ciprofloxacin) or azithromycin based on local resistance patterns
- Children: Azithromycin or third-generation cephalosporin (for infants <3 months or neurologic involvement) 1
3. Special Considerations
- Avoid antimicrobial therapy for suspected STEC O157 and other Shiga toxin 2-producing E. coli due to risk of hemolytic uremic syndrome 1
- Avoid antimotility agents in patients with bloody diarrhea or suspected invasive disease 1
- Modify or discontinue antimicrobial therapy when a specific pathogen is identified 1
4. Monitoring and Follow-up
- Daily assessment of:
- Vital signs and hydration status
- Stool frequency, consistency, and volume
- Abdominal examination
- Laboratory parameters (electrolytes, renal function, inflammatory markers)
- Clinical reevaluation for patients who do not respond to initial therapy 1
- Consider non-infectious causes (IBD, IBS) for symptoms lasting ≥14 days 1
Management of Specific Scenarios
Inflammatory Bowel Disease (IBD) with Enteritis
- Multidisciplinary approach involving gastroenterologist and surgeon 1
- Provide adequate IV fluids, thromboprophylaxis, and correct electrolyte abnormalities 1
- For cecal inflammation due to Crohn's disease:
Intra-abdominal Abscesses
- Abscesses >3 cm: Percutaneous drainage plus antibiotics 1, 3
- Abscesses <3 cm: Antibiotics alone with close monitoring 1, 3
- Antibiotic coverage should include gram-negative and anaerobic bacteria 1
Common Pitfalls to Avoid
- Delaying fluid resuscitation while waiting for diagnostic test results
- Routine use of antibiotics for viral or self-limiting enteritis
- Using antimotility agents in patients with bloody diarrhea or fever
- Failing to consider C. difficile in patients with recent antibiotic use or healthcare exposure
- Not reassessing patients who fail to improve within 48-72 hours
By following this evidence-based approach to enteritis management, clinicians can effectively reduce morbidity and mortality while improving patient outcomes and quality of life.