What antibiotics are used to treat colitis?

From the Guidelines

Antibiotics used to treat colitis, specifically Clostridioides difficile (C. diff) colitis, include oral vancomycin 125 mg four times daily for 10-14 days, or fidaxomicin 200 mg twice daily for 10 days, as the first-line treatment. For severe cases, vancomycin may be increased to 500 mg four times daily 1. Metronidazole 500 mg three times daily for 10-14 days is an alternative but less effective option, and should be limited to the treatment of an initial episode of mild-moderate CDI 1.

Treatment Options

• Oral vancomycin 125 mg four times daily for 10-14 days is considered superior to metronidazole in severe CDI 1
• Fidaxomicin orally 200 mg twice daily for 10 days may be a valid alternative to vancomycin in patients with CDI 1
• Metronidazole should be limited to the treatment of an initial episode of mild-moderate CDI 1

Additional Considerations

• Fecal microbiota transplantation (FMT) is an effective option for patients with multiple CDI recurrences who have failed appropriate antibiotic treatments 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
• Patients with severe CDI who progress to systemic toxicity should undergo early surgical consultation and should be evaluated for potential surgical intervention 1

Guideline Recommendations

• The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) recommends that antibiotics covering a spectrum no broader than necessary should be used, and the antibiotic spectrum of treatment should be narrowed after results of cultures and/or susceptibility tests become known 1
• The ESCMID also recommends that mild CDI may be treated by stopping the inducing antibiotic, and observing patients closely for any signs of clinical deterioration 1

From the FDA Drug Label

Vancomycin is used in treating antibiotic-associated pseudomembranous colitis caused by C. difficile and for staphylococcal enterocolitis The usual adult total daily dosage is 500 mg to 2 g given in 3 or 4 divided doses for 7 to 10 days. The parenteral form of vancomycin hydrochloride may be administered orally for treatment of antibiotic-associated pseudomembranous colitis produced by C. difficile and for staphylococcal enterocolitis.

Vancomycin is used to treat colitis, specifically:

• Antibiotic-associated pseudomembranous colitis caused by C. difficile
• Staphylococcal enterocolitis The recommended dosage is 500 mg to 2 g per day, divided into 3 or 4 doses, for 7 to 10 days 2.

From the Research

Antibiotics for Colitis

• The use of antibiotics to treat colitis, particularly Clostridium difficile (C. difficile) infection, has been studied extensively 3, 4, 5, 6, 7.
• Oral vancomycin is recommended for the treatment of severe C. difficile infection, while metronidazole is the standard of care for non-severe infection 3, 7.
• Vancomycin has been shown to be effective in treating patients with ulcerative colitis and C. difficile infection, with fewer readmissions and shorter lengths of stay compared to metronidazole 3.
• Metronidazole and vancomycin have equivalent efficacy and relapse rates in treating C. difficile-associated diarrhea and colitis, but metronidazole is more economical 7.
• Nitazoxanide has also been shown to be effective in treating patients with C. difficile colitis who fail treatment with metronidazole 5.
• The choice of antibiotic may depend on the severity of the infection, the patient's underlying condition, and the presence of any antibiotic-resistant organisms 4, 6.

Specific Antibiotics

• Vancomycin: effective in treating severe C. difficile infection and ulcerative colitis 3, 7.
• Metronidazole: effective in treating non-severe C. difficile infection, but may have higher relapse rates compared to vancomycin 3, 7.
• Nitazoxanide: effective in treating patients with C. difficile colitis who fail treatment with metronidazole 5.
• Clindamycin: has been associated with an increased risk of C. difficile colitis 4, 6.
• Cephalosporins and broad-spectrum penicillins: may also be associated with an increased risk of C. difficile colitis 4, 6.