What is the recommended treatment for colitis?

From the Guidelines

The treatment of colitis does not typically involve the use of antibiotics as a first-line therapy, except in cases of infectious colitis or complications. The management of colitis, particularly ulcerative colitis, has evolved with guidelines recommending the use of specific medications based on the severity and extent of the disease. For mild to moderate ulcerative colitis, 5-aminosalicylates (5-ASAs) like mesalamine are often recommended as first-line treatments 1. In cases of moderate to severe ulcerative colitis, biologic agents such as infliximab, adalimumab, golimumab, vedolizumab, tofacitinib, or ustekinumab are suggested over no treatment for the induction and maintenance of remission 1.

Key considerations in the treatment of colitis include:

• The specific type and severity of the condition
• The extent of the disease
• Patient factors and preferences
• The potential side effects and risks associated with each treatment option

For example, in adult outpatients with moderate to severe ulcerative colitis, the use of infliximab, adalimumab, golimumab, vedolizumab, tofacitinib, or ustekinumab is recommended for induction and maintenance of remission 1. The choice between these biologic agents may depend on factors such as prior biologic exposure and patient preferences regarding administration routes and potential side effects.

In contrast, antibiotics are generally reserved for specific situations such as infectious colitis or when there are complications that require antimicrobial therapy. The use of antibiotics in the treatment of colitis should be guided by evidence of an infectious cause or a clear clinical indication for their use, rather than as a routine part of managing the condition.

Overall, the treatment of colitis should be individualized, taking into account the latest clinical guidelines and evidence-based recommendations to optimize outcomes in terms of morbidity, mortality, and quality of life.

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.

Treatment of Colitis:

• Vancomycin Hydrochloride Capsules are used to treat C. difficile-associated diarrhea and staphylococcal enterocolitis, which are types of colitis.
• The recommended dose for C. difficile-associated diarrhea is 125 mg administered orally 4 times daily for 10 days.
• The recommended dose for staphylococcal enterocolitis is 500 mg to 2 g administered orally in 3 or 4 divided doses for 7 to 10 days.
• Antibiotics, such as vancomycin, are used to treat colitis caused by bacterial infections. 2

From the Research

Treatment of Colitis

• The treatment of colitis depends on the underlying cause and severity of the disease 3, 4.
• For inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), treatment options include aminosalicylates, corticosteroids, immunomodulators, and biologics 3, 4.
• Antibiotics may be used to treat infectious colitis, such as Clostridium difficile infection (CDI) 5, 6, 7.
• For CDI, oral vancomycin is recommended for severe infection, while metronidazole is the standard of care for non-severe infection 5, 7.
• In patients with IBD and CDI, treatment with a vancomycin-containing regimen may be more effective than metronidazole alone 7.

Use of Antibiotics in Colitis Treatment

• Antibiotics are not typically used as first-line treatment for IBD, but may be used to treat complications such as CDI 3, 5.
• For infectious colitis, antibiotics such as azithromycin may be used empirically to treat suspected invasive bacterial enteropathogens 6.
• The use of antibiotics in IBD treatment should be carefully considered, as they may alter the gut microbiome and potentially exacerbate the disease 4.

Specific Treatment Recommendations

• For ulcerative proctitis, left-sided colitis, and pancolitis, treatment recommendations vary depending on disease severity and extent 3.
• For CDI in patients with IBD, treatment with oral vancomycin or fidaxomicin is recommended, with consideration of fecal microbiota transplant (FMT) for recurrent disease 5.
• Patients with UC and non-severe CDI may benefit from treatment with a vancomycin-containing regimen, which may reduce readmissions and length of stay 7.