August 01, 2022
2 min learn
Early recognition and immediate administration of antibiotics are vital elements in managing neutropenic enterocolitis, a standard and doubtlessly life-threatening situation that may befall pediatric sufferers with most cancers, a overview discovered.
Neutropenic enterocolitis also can have an effect on adults however is most typical amongst kids receiving myelotoxic remedy for most cancers or hematopoietic stem cell transplantation, in line with the authors of the overview.
With the potential to have an effect on everything of a colon, bowel or rectum, the illness may “delay chemotherapy, have an effect on vitamin, require extended hospitalization or surgical procedure, and has different life-threatening issues,” in line with the article.
“We could not discover a good up-to-date overview article about typhlitis/neutropenic enterocolitis in kids with most cancers, so we wrote one!” Joshua Wolf, MBBS, PhD, FRACP, a pediatrician and infectious illness researchers at St. Jude Kids’s Analysis Hospital, tweeted.
When the intestine’s mucous membrane is injured via “chemotherapy, malignant infiltration, radiation remedy, graft vs. host illness or an infection,” colonizing gastrointestinal flora from the intestine additional harm the intestine wall, mentioned co-author Shane J. Cross, PharmD, BCPS, assistant professor of medical pharmacy and translational science on the College of Tennessee Well being Sciences Middle.
Shane J. Cross
“The very first thing to take house is that this can be a vicious cycle, and we purpose for diagnosing and administration to interrupt that vicious cycle,” Cross instructed Healio.
Along with early recognition and immediate administration of antibiotics, the authors mentioned a risk-stratified strategy — matching affected person traits with beneficial empiric remedy — is also vital.
“As soon as it is recognized, we take a stratified strategy in how we’d attempt to handle them with antibiotics,” Wolf mentioned, additionally in a Healio interview. “Primarily based on totally different danger standards, we’d develop the protection of our antibiotics. Then on the on the flip facet, as they enhance, we take an strategy the place we attempt to step down with the antibiotic coverages as they get higher to one thing that is not fairly as broad as different approaches, and in sure circumstances, [we were] in a position to do in an outpatient setting, in the event that they’re nicely sufficient.”
“The central pillars of therapy are empiric antibiotic remedy and supportive care, with surgical procedure reserved for intestinal perforation, extreme bleeding or fulminant illness,” the authors wrote. “Shut monitoring for enchancment, deterioration, or growth of intra-abdominal issues can information subsequent administration. Outcomes are often good, with fast decision after neutrophil restoration.”
They added that what works for one affected person could not work for an additional.
“It isn’t one-size-fits-all,” Cross mentioned. “You have to tailor the remedy to the affected person.”