Early recognition, prompt treatment important in the management of pediatric enterocolitis

Early recognition and prompt administration of antibiotics are important factors in the management of neutropenic enterocolitis, a common and life-threatening condition that can occur in pediatric cancer patients, according to a review.

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

With the potential to affect the entire colon, intestine or rectum, the disease could “delay chemotherapy, affect nutrition, require prolonged hospitalization or surgery and lead to other life-threatening complications”, according to the article.

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

Joshua Wolf

When the gut’s mucous membrane is injured by “chemotherapy, malignant infiltration, radiation therapy, graft-versus-host disease or infection,” colonization of the gut’s gastrointestinal flora further damages the gut wall, said the 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 remember is that this is a vicious cycle, and we’re aiming for diagnosis 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 — is also important.

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

“The central pillars of treatment are empiric antibiotic therapy and supportive care, with surgery reserved for intestinal perforations, 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 generally 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 have to tailor the therapy to the patient.”