Treatment of acute intestinal infections

Aetiotropic therapy: antibiotics and phages

Aetiotropic treatment is aimed at destroying the pathogen. In modern practice, the indications for antibacterial therapy have narrowed due to the use of natural enterosorbents.

Indications for antibiotics in invasive forms of acute intestinal infections depend on severity:

• Severe form: antibiotics are required for all children.
• Moderate form: prescribed to children under 2 years of age.
• Mild form: indicated only for hemocolitis (blood in stool) or infants under 1 year of age from risk groups (immunodeficiencies, central nervous system pathologies).

Antibacterial drugs are prescribed strictly in age-appropriate dosages for a course of 5–7 days. If there is no effect after 2–3 days, the drug is changed.

Step-down therapy:

1. First-line (starting): per os on an outpatient basis (kanamycin, nifuroxazide).
2. Second-line: for moderate/severe course or ineffectiveness of the first-line drugs (aminoglycosides, rifaximin).
3. Third-line (reserve): in the intensive care unit for severe and generalized infections (cephalosporins, carbapenems, fluoroquinolones).

For certain infections, there are specific drugs (chloramphenicol for typhoid fever, erythromycin for cholera). For mild and mild/mild-subclinical forms, specific bacteriophages and lactoglobulins serve as an alternative.

Pathogenetic therapy: oral rehydration (OR)

This is the basis of treatment for dehydration (exicosis). The goal is to eliminate water-electrolyte imbalance using low-osmolarity glucose-salt solutions.

Rules for conducting OR:

• Start from the first hours of the illness.
• Administer fluids strictly in fractional doses: a teaspoon/tablespoon every 5–10 minutes.
• In case of vomiting, OR is not cancelled, but a pause of 5–10 minutes is taken.
• In children under 3 years of age, salt solutions are alternated with salt-free ones (water, tea) without mixing them.

Ratio of solutions (salt : salt-free):

• 1:1 — watery diarrhea.
• 2:1 — vomiting predominates over diarrhea.
• 1:2 — fluid loss through sweat (fever).

Efficacy is assessed by improvement in condition, normalization of diuresis, weight gain, and cessation of diarrhea.

Diet therapy

Starvation in acute intestinal infections is prohibited because it slows down the restoration of the intestinal mucosa. Nutrition should be fractional and sparing.

• Breastfeeding: maintained in full volume, frequency of application is increased (6–8 times), feeding time is shortened.
• Formula feeding: familiar formulas are used, preferably adapted fermented milk formulas.
• Over 1 year of age: fermented milk products, vegetable purees, baked apples, steamed omelets, and mashed meat are permitted.
• Excluded: whole cow's milk, rye bread, raw vegetables, sour fruits, rich broths.

By days 3–5, a transition to a normal diet is possible while maintaining a sparing regimen.

Symptomatic treatment and prevention

At high temperature, antipyretics (ibuprofen, paracetamol) are prescribed. To correct digestion during the diet expansion phase, enzymes (pancreatin) are used, and to eliminate dysbiosis during recovery, probiotics are used.

Important: antiperistaltic drugs (slowing down intestinal motility) are absolutely contraindicated in the acute phase due to the high risk of intussusception.

Prevention of acute intestinal infections includes strict adherence to hygiene: heat treatment of food, use of separate cutting boards for raw and cooked foods, and consumption of boiled/bottled water.

Class and exam questions

What else to study on this topic

• Mechanisms of action of enterosorbents
• Specifics of viral gastroenteritis and the role of probiotics
• Assessment of the degree of exicosis and acid-base balance criteria
• Tactics of intragastric drip administration of solutions
• Use of specific bacteriophages and lactoglobulins

Other topics from the section «Chapter 12. Infectious and parasitic diseases»

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.