Treatment for Enteritis
The treatment for enteritis should be based on the specific etiology, with empiric therapy including broad-spectrum antibiotics, bowel rest, and hydration while awaiting diagnostic results. 1
Diagnostic Approach
- Evaluation should include appropriate diagnostic procedures such as stool examination, culture, and specific tests for suspected pathogens 1
- Contrast-enhanced CT scan is the most reliable examination to diagnose intra-abdominal disease when available 1
- In cases of diarrhea with or without acute abdomen, specific testing for Clostridioides difficile and its toxin should be performed 1
- Multiple stool examinations may be necessary to detect certain pathogens like Giardia, and special stool preparations are required to diagnose cryptosporidiosis and microsporidiosis 1
Treatment Based on Etiology
Sexually Transmitted Enteritis
- For enteritis related to sexual practices (oral-anal contact), treatment should target the specific pathogen identified 1
- In otherwise healthy persons with sexually transmitted enteritis, Giardia lamblia is most frequently implicated 1
- In HIV-infected patients, consider pathogens such as CMV, Mycobacterium avium-intracellulare, Salmonella, Campylobacter, Shigella, Cryptosporidium, Microsporidium, and Isospora 1
Infectious Bacterial Enteritis
- For suspected bacterial enteritis with anorectal exudate or polymorphonuclear leukocytes on Gram stain:
- Ceftriaxone 250 mg IM in a single dose PLUS Doxycycline 100 mg orally twice a day for 7 days 1
- For enteritis caused by Campylobacter, Shigella, or other susceptible bacteria:
Neutropenic Enteritis/Enterocolitis
- Treatment should be non-operative, including broad-spectrum antibiotics and bowel rest 1
- Empiric antimicrobial therapy according to guidelines for "fever with neutropenia" - monotherapy with an anti-pseudomonas β-lactam agent, carbapenem, or piperacillin-tazobactam 1
- Emergency surgery must be reserved only for patients presenting with signs of perforation or ischemia 1
- Resolution is obtained in up to 86% of patients with conservative antibiotic treatment in a median of 6-8 days 1
Cytomegalovirus (CMV) Enteritis/Colitis
- Treatment should be non-operative, including antiviral therapy, broad-spectrum antibiotics, and bowel rest 1
- Emergency surgery must be reserved only for patients presenting with signs of toxic megacolon, fulminant colitis, perforation, or ischemia 1
Supportive Care
- Fluid resuscitation is essential, with oral rehydration for mild to moderate cases and intravenous fluids for severe cases 3
- Bowel rest is recommended, especially in cases of neutropenic enteritis and CMV colitis 1
- Antiemetic, antimotility, and/or antisecretory drugs can be used for symptom control in appropriate cases 3
Special Considerations
- Immunocompromised patients may not present with typical signs and symptoms; diagnosis may require combining signs, symptoms, patient history, and radiological evaluation 1
- In patients with radiation enteritis, home parenteral nutrition (HPN) should not be delayed if oral nutrition/enteral nutrition is obviously inadequate 1
- For patients with chronic intestinal failure due to radiation enteritis, nutritional regimen follows the same criteria adopted for HPN of patients with other causes of chronic intestinal failure 1
Pitfalls and Caveats
- Clinical signs may not be reliable in immunocompromised patients; the more severe the immunocompromission, the less reliable the clinical presentation 1
- Laboratory tests may not accurately reflect the severity of the clinical condition in immunocompromised patients 1
- Empiric antibiotic therapy should be initiated before culture results are available in severe cases, but should be adjusted once specific pathogens are identified 4
- Antibiotic treatment is important in certain etiologies of bacterial gastroenteritis, both for clinical improvement and for eradication of the causative organism from stools 4