From the Guidelines
Infectious colitis treatment should prioritize supportive care with hydration and electrolyte replacement, and antibiotic use should be guided by the specific pathogen, with oral vancomycin 125mg four times daily for 10-14 days being the recommended treatment for C. difficile, as per the most recent guidelines 1.
Causes of Infectious Colitis
Infectious colitis can be caused by various pathogens, including:
- Bacteria: Salmonella, Shigella, Campylobacter, and C. difficile
- Viruses: norovirus, rotavirus
- Parasites: Entamoeba histolytica, Giardia
Treatment of Infectious Colitis
Treatment depends on the specific pathogen, but generally includes:
- Supportive care with hydration and electrolyte replacement
- Antibiotics for bacterial causes:
- Ciprofloxacin 500mg twice daily for 3-5 days for Salmonella or Shigella
- Azithromycin 500mg daily for 3 days for Campylobacter
- Oral vancomycin 125mg four times daily for 10-14 days or fidaxomicin 200mg twice daily for 10 days for C. difficile, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1
- No specific treatment for viral colitis, with resolution typically occurring within 2-3 days with supportive care
- Metronidazole 500-750mg three times daily for 5-10 days for amoebiasis, and tinidazole 2g once or metronidazole 250mg three times daily for 5-7 days for giardiasis
Prevention and Management
Prevention includes:
- Proper food handling
- Hand hygiene
- Avoiding contaminated water Patients should:
- Increase fluid intake
- Consume easily digestible foods
- Seek medical attention if experiencing severe symptoms like high fever, bloody diarrhea, or signs of dehydration It is essential to note that the use of antibiotics should be guided by the specific pathogen and the severity of the infection, as per the guidelines 1 and 1.
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 DIFICID is an antibiotic medicine used to treat an infection called Clostridioides difficile-associated diarrhea (CDAD) in adults and children 6 months of age and older.
The cause of infectious colitis can be C. difficile or Staphylococcus aureus. The treatment for infectious colitis is vancomycin for C. difficile-associated diarrhea and Staphylococcus aureus enterocolitis, and fidaxomicin for C. difficile-associated diarrhea.
- The recommended dose of vancomycin for C. difficile-associated diarrhea is 125 mg administered orally 4 times daily for 10 days.
- The recommended dose of vancomycin for Staphylococcal enterocolitis is 500 mg to 2 g administered orally in 3 or 4 divided doses for 7 to 10 days.
- The recommended dose of fidaxomicin is 200 mg twice daily for 10 days 2 3
From the Research
Causes of Infectious Colitis
- Infectious colitis can be caused by various bacterial enteropathogens, including Shigella, Salmonella, Campylobacter, Shiga toxin-producing Escherichia coli (STEC), and Clostridium difficile 4, 5, 6.
- The infection can occur through contaminated food or water, or through person-to-person contact 4, 5.
- Antibiotic use can also disrupt the normal gut flora, leading to an overgrowth of toxigenic strains of C. difficile and causing colitis 7, 5.
Diagnosis of Infectious Colitis
- Diagnosis is based on clinical presentation, laboratory stool studies, and endoscopy 4, 5, 6.
- Standard stool culture should be performed to identify the causative pathogen 4.
- Multiplex polymerase chain reaction (PCR) followed by guided culture can also confirm active infection 6.
- Epidemiologic findings, such as prior international travel or living in parasite-endemic regions, can suggest the need for specialized studies of etiology 4.
Treatment of Infectious Colitis
- Treatment depends on the causative pathogen and the severity of the disease 4, 5, 6.
- For C. difficile colitis, oral vancomycin is the preferred treatment, with a dose of 125 mg four times daily being as effective as 500 mg four times daily 7.
- For other forms of infectious colitis, pathogen-specific antimicrobial therapy should be initiated 4.
- Empiric treatment with azithromycin may be used for febrile dysenteric diarrhea suspected to be caused by invasive bacterial enteropathogens 4.
- In severe cases, hospitalization and intravenous antibiotics may be necessary 5, 6.