From the Guidelines
Antibiotics should only be used to treat colitis caused by bacterial infections, such as Clostridium difficile, and the choice of antibiotic depends on the severity of the infection and the specific type of colitis present. For infectious colitis caused by bacteria like Clostridium difficile, antibiotics such as oral vancomycin (125mg four times daily for 10-14 days) or fidaxomicin (200mg twice daily for 10 days) are recommended, as stated in the study by Sartelli et al. 1.
Key Considerations
- The use of antibiotics for colitis should be guided by a proper diagnosis, as inappropriate use can disrupt gut flora and potentially worsen colitis symptoms 1.
- For mild CDI, stopping the inducing antibiotic may be sufficient, but patients should be closely monitored for signs of clinical deterioration 1.
- For severe CDI, vancomycin orally 125 mg four times daily for 10 days is considered superior to metronidazole 1.
- Fecal microbiota transplantation (FMT) is an effective option for patients with multiple CDI recurrences who have failed appropriate antibiotic treatments 1.
Treatment Options
- Oral vancomycin (125mg four times daily for 10-14 days) or fidaxomicin (200mg twice daily for 10 days) for infectious colitis caused by bacteria like Clostridium difficile 1.
- Metronidazole for mild-moderate CDI, but it should be limited to the treatment of an initial episode 1.
- Coadjuvant treatment with monoclonal antibodies (bezlotoxumab) may prevent recurrences of CDI, particularly in patients with CDI due to the 027 epidemic strain, in immunocompromised patients and in patients with severe CDI 1.
From the FDA Drug Label
Vancomycin Hydrochloride Capsules are indicated for the treatment of C. difficile-associated diarrhea. Vancomycin Hydrochloride Capsules are also used for the treatment of enterocolitis caused by Staphylococcus aureus (including methicillin-resistant strains) in adult and pediatric patients less than 18 years of age Vancomycin Hydrochloride Capsules for the treatment of colitis are for oral use only and are not systemically absorbed.
Antibiotics for colitis: Vancomycin Hydrochloride Capsules are indicated for the treatment of C. difficile-associated diarrhea and enterocolitis caused by Staphylococcus aureus. The recommended dose for C. difficile-associated diarrhea is 125 mg administered orally 4 times daily for 10 days. For staphylococcal enterocolitis, the total daily dosage is 500 mg to 2 g administered orally in 3 or 4 divided doses for 7 to 10 days 2.
From the Research
Antibiotics for Colitis
- The use of antibiotics for colitis depends on the underlying cause of the infection. For example, patients with Clostridium difficile infection (CDI) may be treated with oral vancomycin or fidaxomicin 3, 4.
- In patients with inflammatory bowel disease (IBD), such as ulcerative colitis (UC) or Crohn's disease (CD), CDI can lead to worse outcomes, including increased readmissions, colectomy, and death 3.
- Vancomycin-containing regimens have been shown to be effective in reducing readmissions and lengths of stay in patients with UC and nonsevere CDI 3.
- Fidaxomicin has also been shown to be effective in treating CDI in patients with IBD, with a response rate of 60.6% 4.
- Long-duration oral vancomycin therapy (21-42 days) has been associated with a lower rate of CDI recurrence compared to short-duration therapy (10-14 days) 5.
Treatment Approaches
- The approach to treating infectious colitis involves identifying the underlying cause of the infection and selecting the appropriate antibiotic therapy 6, 7.
- 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 7.
- Empiric treatment with azithromycin may be considered for adults with febrile dysenteric diarrhea suspected to be caused by invasive bacterial enteropathogens such as Shigella, Salmonella, or Campylobacter 6.