From the Guidelines
For colitis with an allergy to fluoroquinolones, the recommended antibiotic options include metronidazole (500 mg three times daily for 10-14 days) or vancomycin (125 mg four times daily for 10-14 days) for Clostridioides difficile colitis, as suggested by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines 1. When considering treatment options, it's essential to note that the ESCMID guidelines recommend using antibiotics with a spectrum no broader than necessary and narrowing the antibiotic spectrum after culture and susceptibility test results become available 1.
- For mild CDI, stopping the inducing antibiotic may be sufficient, but close monitoring for clinical deterioration is crucial 1.
- For an initial episode or first recurrence of CDI, metronidazole or vancomycin are recommended, depending on the severity of the disease and the possibility of oral therapy 1.
- In cases where oral therapy is impossible, intravenous metronidazole or vancomycin via nasogastric tube or retention enema may be considered 1. The choice of antibiotic should be based on the underlying cause of colitis, severity of symptoms, and patient factors, with careful monitoring for side effects and adjustment of treatment as needed.
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
For a patient with colitis and an allergy to fluoroquinolone, vancomycin can be considered as a treatment option, specifically for C. difficile-associated diarrhea or staphylococcal enterocolitis. The recommended dose for adults is 125 mg administered orally 4 times daily for 10 days for C. difficile-associated diarrhea, and 500 mg to 2 g administered orally in 3 or 4 divided doses for 7 to 10 days for staphylococcal enterocolitis 2.
From the Research
Recommended Antibiotics for Colitis with Allergy to Fluoroquinolone
- The European and American Infectious Diseases Societies recommend fidaxomicin as the first line of treatment and vancomycin as a second choice for Clostridiodes difficile colitis 3.
- Vancomycin is also recommended for the treatment of severe CDI, while metronidazole is the standard of care for nonsevere infection 4.
- A study found that vancomycin was more effective than metronidazole for achieving symptomatic cure, with 79% of vancomycin patients achieving symptomatic cure compared to 72% of metronidazole patients 5.
- Fidaxomicin was found to be more effective than vancomycin for achieving symptomatic cure, with 71% of fidaxomicin patients achieving symptomatic cure compared to 61% of vancomycin patients 5.
- Teicoplanin may be more effective than vancomycin for achieving a symptomatic cure, but the quality of evidence is very low 5.
- Metronidazole is the least expensive antibiotic, with a cost of USD 13 for a 10-day course of treatment, compared to vancomycin (USD 1779) and fidaxomicin (USD 3453.83) 5.
Considerations for Patients with Allergy to Fluoroquinolone
- There is no direct evidence on the use of antibiotics in patients with colitis and an allergy to fluoroquinolone.
- However, the recommended antibiotics for colitis, such as vancomycin, metronidazole, and fidaxomicin, do not belong to the fluoroquinolone class and may be considered as alternatives 3, 4, 5.
- It is essential to note that patients with an allergy to one antibiotic may be at risk of developing an allergy to other antibiotics, and caution should be exercised when prescribing alternative antibiotics 6.