From the Guidelines
For mesmeric panicles and enterocolitis, antibiotics should not be prescribed as these conditions are not recognized medical entities, and enterocolitis treatment depends on the underlying cause. When considering treatment for enterocolitis, it's crucial to identify the specific cause, as antibiotics are only effective against bacterial infections.
- The term "mesmeric panicles" does not correspond to any valid medical condition, and thus, it does not have a recommended treatment.
- For enterocolitis, which refers to inflammation of the small intestine and colon, treatment varies based on the causative agent.
- If bacterial in origin, antibiotics might be considered, but the choice should be guided by the most recent and highest quality evidence, such as the 2017 WSES guidelines for management of intra-abdominal infections 1.
- According to these guidelines, for critically ill patients, options include Piperacillin/Tazobactam 4.5 g 6-hourly, or Cefepime 2 g 8-hourly + Metronidazole 500 mg 6-hourly, among others 1.
- However, the use of antibiotics should be judicious and based on a confirmed bacterial cause, as inappropriate use can lead to adverse outcomes, including antibiotic resistance and worsening of certain conditions like C. difficile enterocolitis.
- Supportive care, including hydration, electrolyte replacement, and dietary modifications, is often the primary approach while awaiting diagnostic testing results to determine the underlying cause of enterocolitis.
- It's essential to seek medical evaluation for gastrointestinal symptoms to ensure appropriate diagnosis and treatment, avoiding self-medication with antibiotics.
From the Research
Mesenteric Panniculitis and Enterocolitis
- Mesenteric panniculitis (MP) is a benign condition characterized by chronic inflammation and fibrosis of adipose tissue mainly of the small bowel mesentery 2.
- The most frequent clinical symptom reported is abdominal pain, followed by bloating/distention, diarrhea, constipation, vomiting, anorexia, weight loss, fever, malaise, and nausea 2.
- First-line medical treatment for MP is prednisone and tamoxifen, while surgery is reserved for cases of recurrent bowel obstruction 2.
Antibiotics for Enterocolitis
- Infectious colitis is diagnosed in someone with diarrhea and one or more of the following: fever and/or dysentery, stools containing inflammatory markers, or positive stool culture for an invasive or inflammatory bacterial enteropathogen 3.
- Standard stool culture should be performed in patients with infectious colitis, and pathogen-specific antimicrobial therapy should be initiated for all forms of infectious colitis other than STEC 3.
- For empiric treatment of febrile dysenteric diarrhea, invasive bacterial enteropathogens (Shigella, Salmonella, and Campylobacter) should be suspected, and adults may be treated empirically with 1000mg azithromycin in a single dose 3.
Antibiotic Therapy for Necrotizing Enterocolitis
- Antibiotic therapy remains a cornerstone of treatment of both medical and surgical presentations of necrotizing enterocolitis (NEC) 4.
- However, guidelines regarding the administration of antibiotics for the treatment of NEC are lacking, and practices vary amongst clinicians 4.
- A systematic review found that there is no sufficient evidence to recommend a specific antibiotic regimen, route of administration, or duration for infants treated for NEC with Bell's stage II and III 5.
Fluoroquinolones for Bacterial Enteritis
- Fluoroquinolones such as norfloxacin, ciprofloxacin, ofloxacin, and fleroxacin have emerged as drugs of choice for treatment of various bacterial enteric infections 6.
- They have been found to be highly effective in the treatment of invasive non-typhoid salmonellosis, typhoid fever, and shigellosis, but have limited usefulness for the routine empirical treatment of bacterial enteritis caused by Salmonella spp and Campylobacter spp 6.