Coccidiosis and necrotic enteritis (NE) are globally common, sometimes intercurrent, diseases of poultry. The risk of NE, due to the Gram-positive bacterium Clostridium perfringens, has increased in recent years because of the voluntary or legally required withdrawal of the use of certain in-feed antibiotic growth promoters with anticlostridial activity. In-feed ionophorous anticoccidial drugs incidentally also possess anticlostridial activity. Such ionophores, although not banned, are usually precluded when live anticoccidial vaccines are used, potentially increasing yet further the risk of NE. This review provides information for the design of rational, integrated management strategies for the prevention and control of coccidiosis and NE in chickens by maintaining gut integrity. Because of differences in local availability of feed ingredients and national legislations regarding antibiotic growth promoters and anticoccidial vaccine licensing, no universal strategy is applicable. The diseases and their interactions are described under the headings of forms of disease, diagnosis, sources of infection, pathophysiological effects, predisposing factors, and control methods. Elements of gut integrity, which influences host predisposition and clinical responses to disease, include physical development, immune competence, gut enzyme activity, mucin production, gut flora and epithelial damage. Experimental studies of coccidiosis and NE are compared, and where possible reconciled, with field observations. Gaps in knowledge and necessary further experiments are identified. Insights are provided regarding interactions between coccidiosis, NE, and the use of live anticoccidial vaccines. Recent changes in NE prevalence in commercial flocks, and their possible causes, are discussed. The necessarily wide range of topics reviewed emphasizes the enormous complexity of this disease combination, and indicates the importance of a multidisciplinary approach in order to reduce its harmful impact on the world's poultry industry.
