Infectious Disease

Early recognition, prompt treatment important in managing pediatric enterocolitis

August 01, 2022

2 min read

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Early recognition and prompt administration of antibiotics are important factors in managing neutropenic enterocolitis, a common and potentially life-threatening condition that can affect pediatric patients with cancer, a review found.

Neutropenic enterocolitis can also affect adults but is most common among children receiving myelotoxic therapy for cancer or hematopoietic stem cell transplantation, according to the authors of the review.

A common yet serious infection that often affects pediatric cancer patients needs to be treated quickly, researchers said. Source: Adobe Stock

With the potential to affect the entirety of a colon, bowel or rectum, the disease could “delay chemotherapy, affect nutrition, require prolonged hospitalization or surgery, and has other life-threatening complications,” according to the article.

“We couldn’t find a good up-to-date review article about typhlitis/neutropenic enterocolitis in children with cancer, so we wrote one!” Joshua Wolf, MBBS, PhD, FRACP, a pediatrician and infectious disease researcher at St. Jude Children’s Research Hospital, tweeted.

Joshua Wolf

When the gut’s mucous membrane is injured through “chemotherapy, malignant infiltration, radiation therapy, graft vs. host disease or infection,” colonizing gastrointestinal flora from the gut further damage the gut wall, said co-author Shane J. Cross, PharmD, BCPS, assistant professor of clinical pharmacy and translational science at the University of Tennessee Health Sciences Center.

Shane J Cross

“The first thing to take home is that this is a vicious cycle, and we aim for diagnostics and management to break that vicious cycle,” Cross told Healio.

In addition to early recognition and prompt administration of antibiotics, the authors said a risk-stratified approach — matching patient characteristics with recommended empirical therapy — also is important.

“Once it’s identified, we take a stratified approach in how we would try to manage them with antibiotics,” Wolf said, also in a Healio interview. “Based on different risk criteria, we would expand the coverage of our antibiotics. Then on the on the flip side, as they improve, we take an approach where we try to step down with the antibiotic coverages as they get better to something that’s not quite as broad as other approaches, and in certain cases, [we were] able to do in an outpatient setting, if they’re well enough.”

“The central pillars of treatment are empirical antibiotic therapy and supportive care, with surgery reserved for intestinal perforation, severe bleeding or fulminant disease,” the authors wrote. “Close monitoring for improvement, deterioration, or development of intra-abdominal complications can guide subsequent management. Outcomes are usually good, with rapid resolution after neutrophil recovery.”

They added that what works for one patient may not work for another.

“It’s not one-size-fits-all,” Cross said. “You’ve got to tailor the therapy to the patient.”

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