What is the treatment for Bacterial Colitis?

From the Guidelines

Bacterial Colitis Treatment

Bacterial colitis treatment should start with supportive care, including fluid replacement and rest, and may involve antibiotics, but their use should be cautious and based on the severity of the condition and the suspected causative organism 1.

Antibiotic Treatment

For mild cases of bacterial colitis, such as those caused by Clostridium difficile (CDI), treatment may involve stopping the inducing antibiotic if possible, and closely monitoring the patient for any signs of clinical deterioration 1.

• Non-severe cases: metronidazole 500 mg tid orally for 10 days may be considered 1.
• Severe cases: vancomycin 125 mg qid orally for 10 days is recommended 1. In cases where oral therapy is impossible, intravenous metronidazole or vancomycin via nasogastric tube may be used 1.

Fecal Microbiota Transplant (FMT)

For severe or fulminant CDI not responding to antimicrobial therapy, conventional FMT may be considered, especially in hospitalized patients, with careful selection of donors and administration methods 1.

Important Considerations

• Antibiotic stewardship: antibiotics should be used judiciously, with the narrowest spectrum possible, and their use should be guided by culture and susceptibility results when available 1.
• Surgical intervention: colectomy may be necessary in cases of perforation, severe ileus, or toxic megacolon that do not respond to medical therapy 1.
• Probiotics and other therapies: while probiotics may help restore normal gut flora, their use should be discussed with a healthcare provider, and other therapies like FMT should be considered in specific contexts, such as severe CDI 1.

Consultation and Monitoring

In all cases, it's crucial to consult a healthcare professional for proper diagnosis and treatment, as the management of bacterial colitis can vary significantly based on the individual's condition, the severity of the disease, and local resistance patterns. Close monitoring of the patient's response to treatment and adjustment of the therapeutic plan as needed is essential.

From the FDA Drug Label

1. 3 Clostridium difficile-Associated Diarrhea (CDAD) Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including amoxicillin and clavulanate potassium, and may range in severity from mild diarrhea to fatal colitis.

The treatment for Bacterial Colitis is not directly stated in the label, but it does mention that antibacterial treatment of C. difficile should be instituted as clinically indicated if CDAD is suspected or confirmed.

• The label does not provide a specific treatment for bacterial colitis.
• It only discusses the potential for CDAD as a complication of antibacterial use and the need to consider it in patients who present with diarrhea following antibacterial use 2.

From the Research

Treatment for Bacterial Colitis

The treatment for bacterial colitis depends on the cause and severity of the infection.

• For empiric treatment of febrile dysenteric diarrhea, invasive bacterial enteropathogens (Shigella, Salmonella, and Campylobacter) should be suspected and adults may be treated empirically with 1000mg azithromycin in a single dose 3.
• Once laboratory diagnosis is made, pathogen-specific antimicrobial therapy should be initiated for all forms of infectious colitis other than STEC 3.
• For Clostridium difficile-associated colitis, oral vancomycin is the most widely tested and is currently the treatment of choice, achieving high concentrations in the feces and being very active against C. difficile in doses of 125-500 mg by mouth every six hours 4.
• Other potentially useful antimicrobials for treating AAC include metronidazole (500 mg by mouth every eight hours) and bacitracin (25,000 units by mouth every six hours) 4.
• In cases of toxic megacolon, non-surgical therapy includes balancing of electrolytes and fluid volumes, broad-spectrum antibiotics including metronidazole, positioning of patients and probably careful intermittent decompression 5.
• For pseudomembranous colitis, vancomycin should be given orally and metronidazole should be given intravenously 5.

Specific Treatment Approaches

• Rifaximin, a non-absorbable broad-spectrum antibiotic, may be useful in the treatment of ulcerative colitis and pouchitis, as it maintains a topical action without systemic effects and the lack of resistant bacterial strains may allow prolonged and repeated treatments 6.
• Multiplex polymerase chain reaction (PCR) followed by guided culture on PCR-positive pathogens can often confirm active infection, while standard culture methods provide isolates for antibiotic susceptibility testing, subtyping, and Whole Genome Sequencing 7.