Analysis of Antibiotic Treatment Regimens for Hirschsprung’s Associated Enterocolitis

Jonathan Vacek; Julia Grabowski

Hirschsprung’s associated enterocolitis (HAEC) is a leading cause of morbidity and mortality in patients with Hirschsprung’s disease (HD). The etiology of this process is unknown and the symptoms are often non-specific. The treatment of HAEC is typically supportive in nature and consists of intravenous fluid resuscitation, antibiotics, and rectal irrigations. Though consensus guidelines for treatment of HAEC have been developed, these guidelines have not been studied in a prospective manner and are variably applied. The aim of our study was to review our institutional experience with HAEC focusing specifically on the antibiotic regimens prescribed and evaluate practice patterns and outcomes.

Patients with HAEC are treated with a wide variety of antibiotic regimens.

A single center retrospective review was performed of all patients with a diagnosis of HD who were admitted from 1/2013-12/2015. From this cohort, antibiotics regimens of patients who also had an associated ICD code for enterocolitis during their admission were reviewed. Demographic data were collected including age, sex, and ethnicity. A descriptive analysis was then performed.

A total of 207 patients with a known diagnosis of HD were admitted during this time period. Of these patients 51 (25%) developed HAEC. The mean of age upon initial development was 3.1 years with a range of 0-18 years. Male predominance was discovered with a total of 33 patients (65%). White-Non Hispanic ethnicity was most common with 25 patients (49%) developing HAEC. Of the patients who developed HAEC the average readmission was one with eleven patients (22%) requiring more than one admission. A total of 12 different antibiotic regimens were identified with the most common being intravenous ampicillin, gentamicin, and flagyl. This regimen had an odds ratio (OR) of 2.3. The average duration for parenteral antibiotic regimens was one day with a range of 0-2 days. Probiotics were used in one patient (2%).

We have described the demographic associations of HAEC and the practice pattern variation for treatment. A high degree of variability in antibiotic regimens exist for treatment of HAEC. This study highlights the need for a prospectively validated antibiotic regimen to decrease the morbidity associated with the disease.