How is infectious proctitis treated?

Updated: Mar 27, 2020
  • Author: David E Stein, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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If the cause of proctitis is infectious, the treatment is targeted toward the pathogen responsible.

Infectious proctitis due to Salmonella species is usually self-limited, and antibiotics are not required. Maintaining adequate fluid and electrolyte balances and providing supportive care are all that is required.

Shigella proctitis is usually self-limited, but the duration may be shortened by the addition of antibiotics. Antibiotics for 1 week may include ampicillin, tetracycline, ciprofloxacin, and trimethoprim-sulfamethoxazole (preferred).

Yersinia proctitis is also self-limited and should not be treated with antibiotics unless systemic septicemia occurs; in which case, antibiotics (eg, trimethoprim-sulfamethoxazole, aminoglycosides, tetracycline, third-generation cephalosporin) should be used.

Campylobacter proctitis is usually self-limited as well.

E histolytica generally is treated with metronidazole and iodoquinol.

Sexually transmitted proctitis requires treatment similar to the corresponding treatment for a genital infection. Chlamydia trachomatis infection is treated with doxycycline; gonorrheal proctitis is treated with ceftriaxone or cefixime. Syphilitic proctitis responds to intramuscular (IM) penicillin G benzathine, and herpes simplex virus type 2 infection is treated with acyclovir.

C difficile infection generally is treated with intravenous (IV) or oral metronidazole or oral vancomycin. [7] A more aggressive C difficile mutation has been seen and may have a rapidly progressive course toward septicemia and toxic colitis. In patients who do not appear to be responding to metronidazole and who have leukocytosis (leukocyte count >20,000/µL), therapy should be switched to oral vancomycin. Vancomycin enemas may also be used in individuals in whom oral antibiotics may not reach a part of the colon (eg Hartman pouch, ileostomy, colonic diversion). Discontinuation of any other antibiotics should be ordered if the clinical situation allows.

Patients colonized with C difficile have a likelihood of recurrence; consequently, whenever they are placed on antibiotics, they should be aware of the possibility of diarrhea. In patients with recurrent C difficile infections, physicians may consider fecal microbiota transplantation, which has been reported to achieve cure rates of 90% and higher in multiple studies.

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