Medication Summary

Most infections are self-limiting. Antibiotics should be given for severe cases. Y enterocolitica isolates usually are susceptible to trimethoprim-sulfamethoxazole, aminoglycosides, third-generation cephalosporins, fluoroquinolones, and tetracyclines; they typically are resistant to first-generation cephalosporins and most penicillins as the organism often produces beta-lactamase. Trimethoprim-sulfamethoxazole is the preferred antibiotic. Cefotaxime and ciprofloxacin are preferred alternatives. Antimicrobial therapy has no effect on postinfectious sequelae.^[6]

Clinical failure with cefotaxime has been reported.^[56]Resistance to macrolides and fluoroquinolones is sporadically reported.^[57]

Antimotility agents are contraindicated in the treatment of Y enterocolitica infection because of the increased risk for invasion.

Class Summary

The value of antibiotic therapy in uncomplicated acute colitis and mesenteric adenitis is not established. Antibiotic treatment may be required in patients with septicemia, with focal extraintestinal manifestations, and in immunocompromised patients with enterocolitis.

Ciprofloxacin (Cipro)

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The bactericidal agent ciprofloxacin is a second-generation quinolone. It acts by interfering with DNA gyrase, by inhibiting the relaxation of supercoiled DNA, and by promoting the breakage of double-stranded DNA. Ciprofloxacin is highly active against gram-negative and gram-positive organisms.

Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS, Septra DS)

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Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS, Septra DS)

The combination antibiotic TMP-SMZ inhibits bacterial growth by inhibiting the synthesis of dihydrofolic acid. It is not helpful in cases of uncomplicated gastroenteritis.

Ceftriaxone (Rocephin)

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Ceftriaxone is a third-generation cephalosporin with gram-negative activity.

Gentamicin

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Gentamicin is an aminoglycoside that is bactericidal for susceptible gram-negative organisms. This agent is not helpful for uncomplicated gastroenteritis.

Cefotaxime (Claforan)

Cefotaxime is a third-generation cephalosporin with a gram-negative spectrum. It has lower efficacy against gram-positive organisms. This agent is not helpful for uncomplicated gastroenteritis.

Tetracycline

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Tetracycline treats gram-positive and gram-negative organisms, as well as mycoplasmal, chlamydial, and rickettsial infections. It inhibits bacterial protein synthesis by binding with the 30S and possibly 50S ribosomal subunit(s).

Chloramphenicol

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Chloramphenicol binds to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. It is effective against gram-negative and gram-positive bacteria.

Piperacillin and tazobactam sodium (Zosyn)

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This drug combination consists of an antipseudomonal penicillin plus a beta-lactamase inhibitor. It inhibits the biosynthesis of cell wall mucopeptide and is effective during the active multiplication stage.

Imipenem/cilastatin (Primaxin)

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In vitro susceptibility to imipenem has been reported.

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Media Gallery

Yersinia enterocolitis in a 45-year-old white woman who presented with chronic diarrhea.
Gram stain of Yersinia enterocolitica.

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Author

Zartash Zafar Khan, MD, FACP Infectious Disease Consultant

Zartash Zafar Khan, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, International Society for Infectious Diseases

Disclosure: Nothing to disclose.

Coauthor(s)

Michelle R Salvaggio, MD, FACP Assistant Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine; Medical Director of Infectious Diseases Institute, Director, Clinical Trials Unit, Director, Ryan White Programs, Department of Medicine, University of Oklahoma Health Sciences Center; Attending Physician, Infectious Diseases Consultation Service, Infectious Diseases Institute, OU Medical Center

Michelle R Salvaggio, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Received honoraria from Merck for speaking and teaching.

Daniel R Bronfin, MD Clinical Professor of Pediatrics, Tulane University School of Medicine; Vice Chairman of Pediatrics, Ochsner Children's Health Center

Daniel R Bronfin, MD is a member of the following medical societies: American Academy of Pediatrics, American Cleft Palate-Craniofacial Association

Disclosure: Nothing to disclose.

Chief Editor

John L Brusch, MD, FACP Corresponding Faculty Member, Harvard Medical School

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Daniel R Bronfin, MD Head, General Academic Pediatrics, Ochsner Children's Health Center

Daniel R Bronfin, MD is a member of the following medical societies: American Academy of Pediatrics and American Cleft Palate/Craniofacial Association