From the Guidelines
For stercoral proctitis, antibiotics are not the primary treatment, but if secondary infection is suspected, vancomycin or fidaxomicin may be considered based on their effectiveness against Clostridium difficile, a common cause of infectious diarrhea. The treatment of stercoral proctitis primarily involves relieving the fecal impaction through stool softeners, laxatives, and manual disimpaction 1. However, if there are signs of secondary infection, antibiotics may be necessary. In such cases, the choice of antibiotic should cover common gut flora, including Clostridium difficile. According to the 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA), vancomycin 125 mg given 4 times daily for 10 days or fidaxomicin 200 mg given twice daily for 10 days are recommended for the treatment of Clostridium difficile infection 1. These antibiotics are effective against Clostridium difficile and may be considered if secondary infection is suspected in stercoral proctitis. It's essential to address the underlying constipation through increased fluid intake, dietary fiber, and regular bowel habits to prevent recurrence. Patients should be monitored for complications such as ulceration, bleeding, or perforation, which would require more aggressive intervention. The use of antibiotics should be guided by clinical judgment and suspicion of secondary infection, rather than as a first-line treatment for stercoral proctitis. In general, the treatment of stercoral proctitis should focus on relieving the fecal impaction and preventing recurrence, with antibiotics reserved for cases with suspected secondary infection.
From the FDA Drug Label
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action Piperacillin and tazobactam is an antibacterial drug [see Microbiology (12.4)].
The antibiotic used to treat infections, including Stercoral (Fecal) Proctitis, is piperacillin-tazobactam.
- Piperacillin is a penicillin antibiotic
- Tazobactam is a beta-lactamase inhibitor This combination is used to treat various bacterial infections, including those in the gastrointestinal tract. However, the label does not explicitly state its use for Stercoral (Fecal) Proctitis, but based on its mechanism of action and pharmacodynamics, it can be considered for treatment of bacterial infections in this area 2.
From the Research
Treatment of Stercoral (Fecal) Proctitis
- The treatment of Stercoral (Fecal) Proctitis involves addressing the underlying cause of fecal impaction and preventing complications such as bowel obstruction, stercoral ulcer, perforation, peritonitis, or cardiopulmonary collapse with hemodynamic instability 3.
- Treatment options include manual fragmentation and extraction of the fecal mass, distal colonic cleansing using enemas and rectal lavage with the aid of a sigmoidoscope, and/or using water-soluble contrast media such as Gastrografin to both identify the extent of the impaction and aid in cleansing and removal 3.
- In cases of stercoral colitis complicated with ischemic colitis, treatment with IV fluids and antibiotics is indicated, along with enema, laxative, and manual disimpaction of stool 4.
- Surgical resection of the involved colon or rectum is reserved for peritonitis resulting from bowel perforation 3.
- Post-treatment evaluation should include a colonic evaluation by flexible sigmoidoscopy, a colonoscopy, or a barium enema after the fecal impaction resolves, and an evaluation of causes to create a preventive therapy plan 5.
Antibiotics Used
- There is no specific mention of the type of antibiotics used to treat Stercoral (Fecal) Proctitis in the provided studies.
- However, it is mentioned that antibiotics are used in the treatment of stercoral colitis complicated with ischemic colitis 4.
Prevention
- Preventive measures such as increasing daily water and fiber intake, limiting medications that decrease colonic motility, using secretagogues or prokinetic agents, and treating underlying anatomic defects are highly important to prevent recurrence of fecal impaction 3.