From the Guidelines
For colitis outpatients with allergies to ciprofloxacin and penicillin, the most effective treatment option is to use biologics such as infliximab, adalimumab, golimumab, vedolizumab, tofacitinib, or ustekinumab, as recommended by the AGA guidelines 1. These medications have been shown to be superior to placebo for induction and maintenance of remission in patients with moderate to severe ulcerative colitis. The choice of biologic agent depends on the specific patient factors and disease severity. Some key points to consider when using these medications include:
- Infliximab, adalimumab, golimumab, vedolizumab, tofacitinib, and ustekinumab are all effective options for induction and maintenance of remission in patients with moderate to severe ulcerative colitis 1.
- Tofacitinib should be used with caution, as high doses have been associated with an increased risk of pulmonary embolism and all-cause mortality 1.
- The AGA recommends using infliximab or vedolizumab over adalimumab for induction of remission in biologic-naive patients 1.
- Patients who have previously been exposed to infliximab may benefit from treatment with ustekinumab or tofacitinib 1.
- Supportive care, including hydration, electrolyte replacement, and dietary modifications, should also be provided to patients with colitis.
- Patients should be monitored for medication side effects and disease progression, with follow-up within 2-4 weeks of starting treatment. It's worth noting that the evidence from 1, 1, and 1 also supports the use of biologics in the treatment of colitis, but the most recent and highest quality evidence is from 1.