Proctitis and Proctocolitis Organism-Specific Therapy 

Proctitis and Proctocolitis Organism-Specific Therapy 

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Organism-specific therapeutic regimens for proctitis and proctocolitis are provided below, including those for Neisseria gonorrhoeae, Chlamydiatrachomatis, Treponema pallidum, herpes simplex virus (HSV), Shigella, Salmonella, Entamoeba histolytica, and Clostridium difficile. [1, 2, 3, 4, 5, 6, 7, 8]

Empiric treatment should be directed at the etiology that is most likely on the basis of the history.

Regimens are as follows:

Regimens are as follows:

Regimens are as follows:

Regimens are as follows:

5-Day regimens for first-time infection are as follows:

5-Day to 10-day regimens for HIV-infected patients are as follows:

Regimens are as follows [10] :

Regimens are as follows [11, 12] :

Regimens are as follows [13, 14, 15, 16] :

In addition to initiating therapy as below, [17, 18, 19] discontinue other antimicrobials as soon as possible.

Mild to moderate disease:

Severe disease:

Additional therapeutic options:

Newer FDA-approved therapeutic options:

Emerging but not yet validated therapeutic options:

Diagnostic testing is as follows:

Special considerations include the following:

Rompalo AM. Proctitis and proctocolitis. Klausner JD, Hook EW III, eds. CURRENT Diagnosis & Treatment of Sexually Transmitted Diseases. New York: McGraw-Hill; 2007. [Full Text].

Trier JS. Acute diarrheal disorders. Greenberger NJ, Blumberg RS, Burakoff R, eds. CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy. 3rd ed. New York: McGraw-Hill; 2016. Chap 5.

[Guideline] McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 Mar 19. 66 (7):e1-e48. [Medline].

[Guideline] de Vries HJ, Zingoni A, White JA, Ross JD, Kreuter A. 2013 European Guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens. Int J STD AIDS. 2014 Jun. 25 (7):465-74. [Medline].

[Guideline] Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5. 64 (RR-03):1-137. [Medline].

[Guideline] Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013 Apr. 108 (4):478-98; quiz 499. [Medline].

Drugs for Parasitic Infections. 3rd ed. New Rochelle, NY: Medical Letter; 2013. e1-e31.

Drugs for sexually transmitted infections. Treat Guidel Med Lett. 2004 Oct. 2 (26):67-74. [Medline].

Stoner BP, Cohen SE. Lymphogranuloma Venereum 2015: Clinical Presentation, Diagnosis, and Treatment. Clin Infect Dis. 2015 Dec 15. 61 Suppl 8:S865-73. [Medline].

Bennish ML, Salam MA, Haider R, Barza M. Therapy for shigellosis. II. Randomized, double-blind comparison of ciprofloxacin and ampicillin. J Infect Dis. 1990 Sep. 162 (3):711-6. [Medline].

Onwuezobe IA, Oshun PO, Odigwe CC. Antimicrobials for treating symptomatic non-typhoidal Salmonella infection. Cochrane Database Syst Rev. 2012 Nov 14. 11:CD001167. [Medline].

Wiström J, Jertborn M, Ekwall E, Norlin K, Söderquist B, Strömberg A, et al. Empiric treatment of acute diarrheal disease with norfloxacin. A randomized, placebo-controlled study. Swedish Study Group. Ann Intern Med. 1992 Aug 1. 117 (3):202-8. [Medline].

Rayan HZ. Microscopic overdiagnosis of intestinal amoebiasis. J Egypt Soc Parasitol. 2005 Dec. 35 (3):941-51. [Medline].

Gonzalez-Ruiz A, Haque R, Rehman T, Aguirre A, Jaramillo C, Castañon G, et al. A monoclonal antibody for distinction of invasive and noninvasive clinical isolates of Entamoeba histolytica. J Clin Microbiol. 1992 Nov. 30 (11):2807-13. [Medline].

Haque R, Kress K, Wood S, Jackson TF, Lyerly D, Wilkins T, et al. Diagnosis of pathogenic Entamoeba histolytica infection using a stool ELISA based on monoclonal antibodies to the galactose-specific adhesin. J Infect Dis. 1993 Jan. 167 (1):247-9. [Medline].

Fotedar R, Stark D, Beebe N, Marriott D, Ellis J, Harkness J. Laboratory diagnostic techniques for Entamoeba species. Clin Microbiol Rev. 2007 Jul. 20 (3):511-32, table of contents. [Medline].

Venugopal AA, Johnson S. Fidaxomicin: a novel macrocyclic antibiotic approved for treatment of Clostridium difficile infection. Clin Infect Dis. 2012 Feb 15. 54 (4):568-74. [Medline].

Rokas KE, Johnson JW, Beardsley JR, Ohl CA, Luther VP, Williamson JC. The Addition of Intravenous Metronidazole to Oral Vancomycin is Associated With Improved Mortality in Critically Ill Patients With Clostridium difficile Infection. Clin Infect Dis. 2015 Sep 15. 61 (6):934-41. [Medline].

Bagdasarian N, Rao K, Malani PN. Diagnosis and treatment of Clostridium difficile in adults: a systematic review. JAMA. 2015 Jan 27. 313 (4):398-408. [Medline].

Peng Z, Ling L, Stratton CW, Li C, Polage CR, Wu B, et al. Advances in the diagnosis and treatment of Clostridium difficile infections. Emerg Microbes Infect. 2018 Feb 7. 7 (1):15. [Medline]. [Full Text].

Goyal H, Perisetti A, Rehman MR, Singla U. New and emerging therapies in treatment of Clostridium difficile infection. Eur J Gastroenterol Hepatol. 2018 Jun. 30 (6):589-597. [Medline].

Jump RLP, Crnich CJ, Mody L, Bradley SF, Nicolle LE, Yoshikawa TT. Infectious Diseases in Older Adults of Long-Term Care Facilities: Update on Approach to Diagnosis and Management. J Am Geriatr Soc. 2018 Apr. 66 (4):789-803. [Medline].

Leandro Feo, MD Resident Physician, Department of General Surgery, Hahnemann University Hospital, Drexel University College of Medicine

Leandro Feo, MD is a member of the following medical societies: American College of Surgeons

Disclosure: Nothing to disclose.

David E Stein, MD Chief, Division of Colorectal Surgery, Associate Professor, Department of Surgery, Director, Mini-Medical School Program, Drexel University College of Medicine; Chief, Division of Colorectal Surgery, Department of Surgery, Hahneman University Hospital; Consultant, Merck; Consultant, Ethicon Endo-Surgery; Consultant, Health Partners; Consultant, Cook Surgical

David E Stein, MD is a member of the following medical societies: American College of Surgeons, American Society of Colon and Rectal Surgeons, Association for Surgical Education, Pennsylvania Medical Society, Society for Surgery of the Alimentary Tract, Crohn’s and Colitis Foundation of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Merck<br/>Serve(d) as a speaker or a member of a speakers bureau for: Merck.

Alexander Crean, MD Fellow in Colorectal Surgery, Department of Surgery, Stony Brook University Hospital and NYU Winthrop Hospital

Alexander Crean, MD is a member of the following medical societies: American College of Surgeons, American Society of Colon and Rectal Surgeons

Disclosure: Nothing to disclose.

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Proctitis and Proctocolitis Organism-Specific Therapy 

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