From the Guidelines
The treatment for infectious colitis should prioritize the use of oral vancomycin 125 mg four times daily for 10 days for severe cases, as recommended by the most recent and highest quality study 1. When considering the treatment for infectious colitis, it's essential to identify the specific pathogen causing the infection. For bacterial causes like Clostridium difficile, antibiotics are often prescribed.
- Common antibiotic regimens include metronidazole 500mg three times daily for 10-14 days for mild to moderate cases.
- Oral vancomycin 125 mg four times daily for 10 days is considered superior to metronidazole in severe cases 1.
- Fidaxomicin orally 200 mg twice daily for 10 days may be a valid alternative to vancomycin in patients with CDI, particularly in those at high risk for recurrence 1. Regardless of the cause, maintaining hydration is crucial, using oral rehydration solutions or, in severe cases, intravenous fluids.
- Probiotics like Lactobacillus or Saccharomyces boulardii may help restore gut flora.
- Antimotility agents such as loperamide should generally be avoided in infectious colitis as they can prolong the infection by reducing pathogen clearance. Treatment should begin promptly after diagnosis, as early intervention reduces symptom duration and prevents complications like dehydration or electrolyte imbalances.
- The choice of antibiotic should consider local resistance patterns and the patient's specific condition. In cases of severe CDI, patients who progress to systemic toxicity should undergo early surgical consultation and be evaluated for potential surgical intervention, with resection of the entire colon or diverting loop ileostomy with colonic lavage as possible alternatives 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
The treatment for infectious colitis, specifically C. difficile-associated diarrhea and staphylococcal enterocolitis, is vancomycin administered orally. The recommended dose for:
- C. difficile-associated diarrhea is 125 mg administered orally 4 times daily for 10 days.
- Staphylococcal enterocolitis is a total daily dosage of 500 mg to 2 g administered orally in 3 or 4 divided doses for 7 to 10 days 2.
From the Research
Treatment Options for Infectious Colitis
The treatment for infectious colitis depends on the cause and severity of the infection. Some of the treatment options include:
- Antimicrobial therapy, which is effective for most forms of infectious colitis 3
- Fecal Microbiota Transplantation (FMT), which has been shown to be effective in treating recurrent Clostridium difficile infection (RCDI) 4, 5, 6, 7
- Vancomycin and metronidazole, which are standard treatments for Clostridium difficile-associated diarrhea, but may not be effective in severe cases 4, 6
Fecal Microbiota Transplantation (FMT)
FMT has emerged as a promising treatment for RCDI, with high success rates in clinical trials 5, 6. The procedure involves the transfer of fecal matter from a healthy donor into the gastrointestinal tract of the patient, aiming to restore the gut microbiota. FMT has been shown to be effective in treating patients with pseudomembranous colitis, a severe form of Clostridium difficile infection 4, 6.
Approach to Diagnosis and Treatment
A prompt diagnosis and management of acute colitis are crucial to prevent severe complications. A 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 3. The treatment approach should be tailored to the specific cause of the infection, and FMT may be considered for patients with recurrent or resistant Clostridium difficile infection.