eMedicine Specialties > Infectious Diseases > Bacterial Infections

Yersinia Enterocolitica: Treatment & Medication

Author: Zartash Zafar Khan, MD, Fellow in Infectious Diseases, University of Oklahoma Health Science Center
Coauthor(s): Michelle R Salvaggio, MD, Assistant Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine; Medical Director of Infectious Diseases Institute, University of Oklahoma Health Sciences Center; Mark H Johnston, MD, Associate Professor of Medicine, Uniformed Services University of Health Sciences; Consulting Staff, Lancaster Gastroenterology Inc; Gregory J Martin, MD, Director, Infectious Diseases Clinical Research Program (IDCRP) Associate Professor of Medicine, Uniformed Services University, Bethesda, MD
Contributor Information and Disclosures

Updated: Apr 9, 2009

Treatment

Medical Care

  • The value of antibiotic therapy in uncomplicated acute diarrhea has not been established. Diarrhea should be managed with fluid and electrolyte replacement.
  • In cases of severe enterocolitis, antibiotics have shown some benefit in terms of shortening the duration of illness. Patient populations who should be considered for empiric antibiotic therapy include elderly patients, patients with diabetes, patients with cirrhosis, immunocompromised patients, patients with cancer receiving chemotherapy, and health care workers and child care workers who are at an increased risk of person-to-person spread.
  • The treatment of mesenteric adenitis is symptomatic.
  • Antibiotic treatment should be used in patients with bacteremia with extraintestinal manifestations.
  • Antibiotics should be used in cases of primary extraintestinal syndromes, such as cellulitis, ophthalmitis, endocarditis, meningitis, osteomyelitis, pneumonia, and focal abscesses, among others.

Surgical Care

  • Abscesses may require surgical drainage.
  • Surgical exploration may be warranted if appendicitis cannot be safely ruled out.
  • Laparotomy findings usually include mesenteric lymphadenitis and terminal ileitis, with a healthy appendix.

Consultations

The diagnosis and management of yersiniosis does not require specific consultations.

  • Consultation with an infectious disease specialist or gastroenterologist may be useful.
  • Consultation with a rheumatologist may be helpful in cases of erythema nodosum or reactive arthritis.

Diet

No special diet is required in patients with Y enterocolitica infection.

Activity

  • No activity restrictions are indicated.
  • Stool samples from infected patients should be handled carefully to avoid infecting others, and strict hygiene practices should be maintained.

Medication

Treatment of Y enterocolitica infection is usually supportive and directed at maintaining euvolemia. Antibiotics may be used in some cases. Septicemia carries a high mortality rate and should therefore be treated with antibiotics.

Y enterocolitica is usually susceptible in vitro to aminoglycosides, chloramphenicol, tetracycline, trimethoprim-sulfamethoxazole, piperacillin, ciprofloxacin, and third-generation cephalosporins. Isolates are often resistant to penicillin, ampicillin, and first-generation cephalosporins, as the organism often produces beta-lactamase. Clinical failure with cefotaxime has been reported.17 Resistance to macrolides and fluoroquinolones is sporadically reported.18 Clinically, Y enterocolitica infection responds well to aminoglycosides, trimethoprim-sulfamethoxazole, ciprofloxacin, and doxycycline.

Antibiotics

The value of antibiotic therapy in uncomplicated acute colitis and mesenteric adenitis is not established.

Antibiotic therapy may be required in patients with septicemia, with focal extraintestinal manifestations, and in immunocompromised patients with enterocolitis.


Ciprofloxacin (Cipro)

Second-generation quinolone. Acts by interfering with DNA gyrase, inhibiting relaxation of supercoiled DNA, and promoting breakage of double-stranded DNA. It is bactericidal. Highly active against gram-negative and gram-positive organisms.

Adult

500 mg PO q12h or 400 mg IV q12h

Pediatric

<18 years: Not recommended
>18 years: Administer as in adults

Antacids decrease absorption; probenecid interferes with renal tubular secretion of ciprofloxacin; enhances anticoagulation effect of warfarin; hypoglycemia risk with glyburide

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Occasional nausea and vomiting; rare reports of tendon rupture, photosensitivity/phototoxicity, QTc prolongation, peripheral neuropathy, and seizure; severe allergic reactions; hepatitis; bone marrow suppression; interstitial nephritis


Sulfamethoxazole (SMZ) and trimethoprim (TMP) (Bactrim, Septra)

Combination antibiotic. Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid.

Adult

160 mg TMP/800 mg SMZ PO q12h for 3 d

Pediatric

<2 months: Do not administer
>2 months: 150 mg TMP/m2/d PO bid for 3 d

May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases incidence of thrombocytopenia purpura in elderly people; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase levels of zidovudine

Documented hypersensitivity; megaloblastic anemia due to folate deficiency

Pregnancy

C - Safety for use during pregnancy has not been established.

Precautions

Discontinue at first appearance of skin rash or signs of adverse reaction; discontinue at first signs of Stevens-Johnson syndrome; obtain CBCs frequently; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, administer 5-15 mg/d leucovorin); caution in pregnancy, breastfeeding women, folate deficiency (eg, people with chronic alcoholism, elderly patients, patients receiving anticonvulsant therapy, patients with malabsorption syndrome); hemolysis may occur in G-6-PD deficient individuals; patients with AIDS may not tolerate or respond to TMP-SMZ; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); administer fluids to prevent crystalluria and stone formation


Ceftriaxone (Rocephin)

Third-generation cephalosporin with gram-negative activity.

Adult

1 g IV qd for 3 d

Pediatric

<7 days: Not established
>7 days: 25-50 mg/kg/d IV/IM; not to exceed 125 mg/d
Infants and children: 50-75 mg/kg/d IV/IM divided q12h; not to exceed 2 g/d

Probenecid may increase ceftriaxone levels; coadministration with ethacrynic acid, furosemide, and aminoglycosides may increase nephrotoxicity

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Diarrhea has been reported with nearly every class of antibiotic and is common with ceftriaxone; associated with gallbladder sludge and cholecystitis; caution in allergy to penicillin

More on Yersinia Enterocolitica

Overview: Yersinia Enterocolitica
Differential Diagnoses & Workup: Yersinia Enterocolitica
Treatment & Medication: Yersinia Enterocolitica
Follow-up: Yersinia Enterocolitica
Multimedia: Yersinia Enterocolitica
References
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References

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Further Reading

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Keywords

Yersinia enterocolitica, Y enterocolitica, Yersinia enterocolitis, yersiniosis, acute bacterial gastroenteritis, bacterial gastroenteritis, gastroenteritis, food poisoning, food contamination, water contamination, mesenteric adenitis, enterocolitis

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Contributor Information and Disclosures

Author

Zartash Zafar Khan, MD, Fellow in Infectious Diseases, University of Oklahoma Health Science Center
Zartash Zafar Khan, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and International Society for Infectious Diseases
Disclosure: Nothing to disclose.

Coauthor(s)

Michelle R Salvaggio, MD, Assistant Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine; Medical Director of Infectious Diseases Institute, University of Oklahoma Health Sciences Center
Michelle R Salvaggio, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Merck Honoraria Speaking and teaching

Mark H Johnston, MD, Associate Professor of Medicine, Uniformed Services University of Health Sciences; Consulting Staff, Lancaster Gastroenterology Inc
Mark H Johnston, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Gregory J Martin, MD, Director, Infectious Diseases Clinical Research Program (IDCRP) Associate Professor of Medicine, Uniformed Services University, Bethesda, MD
Gregory J Martin, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Thomas Herchline, MD, Professor of Medicine, Wright State University Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio
Thomas Herchline, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard B Brown, MD, FACP, Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine
Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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