What is the treatment for infectious colitis?

From the Guidelines

The treatment for infectious colitis, specifically for C. difficile infections, should be oral vancomycin (125mg four times daily for 10 days) or fidaxomicin (200mg twice daily for 10 days), as these are considered superior to metronidazole in severe cases 1.

Key Considerations

• The choice of antibiotic depends on the severity of the infection, with metronidazole limited to mild-moderate cases and vancomycin or fidaxomicin preferred for severe cases.
• 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 high-risk patients 1.
• Patients with severe CDI who progress to systemic toxicity should undergo early surgical consultation and may require resection of the entire colon or diverting loop ileostomy with colonic lavage 2, 1.

Treatment Approach

• For mild cases of C. difficile infection, metronidazole (500mg three times daily for 10-14 days) may be used, but vancomycin or fidaxomicin are preferred for severe cases.
• Supportive care, including fluid and electrolyte replacement, is essential to prevent dehydration and support the body's immune response.
• Probiotics may help restore gut flora, but their use should be individualized based on patient needs and response to treatment.

Surgical Intervention

• Resection of the entire colon should be considered for patients with fulminant colitis, but diverting loop ileostomy with colonic lavage is a useful alternative 2, 1.
• Early surgical consultation is crucial for patients with severe CDI who progress to systemic toxicity, as prompt intervention can improve outcomes.

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 caused by C. difficile or Staphylococcus aureus is Vancomycin Hydrochloride Capsules.

• 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 3.

From the Research

Treatment Options for Infectious Colitis

• The treatment for infectious colitis, specifically Clostridium difficile infection (CDI), includes several antibiotics such as metronidazole, vancomycin, and fidaxomicin 4, 5.
• Vancomycin and metronidazole have been shown to have similar efficacy in treating CDI, although the optimal dose and duration of therapy are still unclear 4.
• Fidaxomicin has been found to be slightly more efficacious than vancomycin in some studies, and may have a role in treating CDI, particularly in patients with recurrent infection 4, 5.
• Fecal bacteriotherapy has also been shown to be highly efficacious in treating CDI, particularly in patients with recurrent infection 4.
• For patients with inflammatory bowel disease (IBD) and CDI, vancomycin-containing regimens may be more effective than metronidazole in reducing readmissions and length of stay 6.
• In cases of acute severe ulcerative colitis, medical treatment with intravenous corticosteroids and medical rescue therapy with cyclosporine or infliximab may be necessary, with surgical intervention (colectomy) considered if medical therapy is unsuccessful 7.
• Vancomycin is also recommended for the treatment of pseudomembranous colitis caused by C. difficile, particularly when removal of the offending antimicrobial agent does not result in clinical improvement 8.

Specific Patient Populations

• Patients with ulcerative colitis and CDI may benefit from vancomycin-containing regimens, which have been shown to reduce readmissions and length of stay 6.
• Patients with recurrent CDI may benefit from fidaxomicin or fecal bacteriotherapy, which have been shown to be effective in treating this condition 4, 5.
• Patients with acute severe ulcerative colitis may require aggressive medical and surgical treatment to reduce mortality and prevent complications such as toxic megacolon and perforation 7.