What is the treatment for streptococcal colitis?

Treatment of Streptococcal Colitis

For streptococcal colitis, treatment should include penicillin or amoxicillin as first-line therapy, with a minimum duration of 10 days to prevent sequelae of streptococcal disease. 1, 2

Diagnosis and Initial Assessment

• Confirm diagnosis through:

  • Stool cultures to identify streptococcal infection
  • C. difficile toxin assay to rule out C. difficile infection 3, 4
  • Complete blood count, inflammatory markers, electrolytes, liver function tests

• Clinical features suggesting streptococcal colitis:

  • Watery diarrhea, possibly with blood, pus, or mucus
  • Fever, tenesmus, abdominal pain
  • Possible systemic toxicity in severe cases 5

Antibiotic Treatment

First-line therapy:

• Amoxicillin:
  • Adults: 500 mg every 8 hours or 875 mg every 12 hours 1
  • Children: 45 mg/kg/day in divided doses every 12 hours 1
  • Duration: Minimum 10 days to prevent acute rheumatic fever 1, 2

Alternative options (for penicillin-allergic patients):

• Clindamycin:
  • Adults: 600 mg to 1,200 mg per day in 3-4 divided doses 6
  • Children: 20-40 mg/kg/day in 3-4 divided doses 6
  • Note: Use with caution due to risk of C. difficile infection 7

Supportive Care

• Fluid and electrolyte replacement for dehydration
• Nutritional support if needed
• Monitor for complications such as toxic megacolon or perforation 7
• Consider hospitalization for severe cases with systemic toxicity 3

Special Considerations

• If patient fails to improve within 48-72 hours:

  • Reassess diagnosis
  • Consider alternative antibiotics based on culture and sensitivity
  • Evaluate for complications

• For severe disease with systemic toxicity:

  • Consider IV antibiotics
  • Surgical consultation may be necessary 3

Prevention of Recurrence

• Complete the full course of antibiotics (minimum 10 days)
• Follow-up stool cultures may be needed to confirm eradication
• Proper hand hygiene and infection control measures to prevent spread

Important Caveats

• Discontinue any unnecessary antibiotics that may alter gut flora 3
• Avoid proton pump inhibitors if possible during treatment 3
• If C. difficile co-infection is present, treat accordingly with oral vancomycin, metronidazole, or fidaxomicin 3
• Monitor for antibiotic-associated adverse effects, including paradoxical worsening of colitis 7

Remember that treatment must be continued for a minimum of 10 days for streptococcal infections to prevent complications like acute rheumatic fever, even if symptoms improve earlier 1, 2.