From the Guidelines
Antibiotic-associated colitis, also known as Clostridioides difficile infection (CDI), is typically treated with oral vancomycin or fidaxomicin.
Treatment Options
- Oral vancomycin 125 mg four times daily for 10 days is considered a first-line treatment for CDI, especially for severe cases 1.
- Fidaxomicin 200 mg twice daily for 10 days is a valid alternative to vancomycin, particularly for patients at higher risk of recurrence 1.
- Metronidazole 500 mg three times daily for 10 days may be used for mild to moderate CDI, but its use is limited due to the risk of cumulative and potentially irreversible neurotoxicity 1.
Special Considerations
- For patients with multiple recurrences of CDI, treatment options include oral vancomycin using a tapered and pulsed regimen, fidaxomicin, or fecal microbiota transplantation 1.
- In patients who cannot tolerate oral antibiotics, vancomycin may be administered as a retention enema via a large rectal tube or catheter 1.
- Colectomy should be considered for patients with severe CDI who do not respond to medical therapy, particularly those with perforation of the colon, systemic inflammation, or deteriorating clinical condition 1.
From the Research
Treatment Options
- The treatment for antibiotic-associated colitis depends on the severity of the illness, with mild cases potentially being treated with metronidazole or vancomycin 2, 3.
- Vancomycin is recommended for the treatment of severe illness 2, 4.
- Oral therapy is preferred over other forms of treatment due to its reliability 2.
- Other potential treatment options include bacitracin, fusidic acid, and rifaximine, which have been shown to be as effective as vancomycin for initial symptomatic resolution 5.
- Teicoplanin may be slightly more effective than vancomycin, but its availability is limited in some countries 5.
Treatment Approach
- The treatment approach typically involves discontinuation of the causative antimicrobial agent, bowel rest, and supportive care with fluids, electrolytes, and colloids if necessary 6.
- Antiperistaltic agents and corticosteroids are not recommended for treatment 6.
- Anion-exchange resins, such as cholestyramine, may be used to bind the cytotoxin found in stools of patients with antibiotic-associated colitis, but combination therapy with vancomycin should be used cautiously 6.
Recurrence and Prevention
- Recurrence of colitis is common, with 18% of patients developing a recurrence after treatment is discontinued 4.
- Treatment with oral vancomycin, metronidazole, or bacitracin can be effective for recurrent episodes 2, 4.
- Novel approaches, such as the oral or rectal introduction of competing nonpathogenic organisms, may prove to be more successful in preventing relapses 2.