What antibiotics can be used to treat infectious colitis?

From the Guidelines

Antibiotics such as metronidazole, vancomycin, fidaxomicin, and ciprofloxacin are commonly used to treat infectious colitis, with the choice of antibiotic depending on the specific pathogen causing the infection and the severity of the disease. For Clostridioides difficile colitis, the most recent and highest quality study 1 recommends oral vancomycin (125 mg four times daily for 10 days) as the preferred treatment for severe cases or recurrent infections, while oral metronidazole (500 mg three times daily for 10-14 days) is often used for mild to moderate cases. Some key points to consider when treating infectious colitis include:

• The use of antibiotics should be guided by stool culture results when available, as antibiotic resistance is increasingly common 1.
• Antibiotics are not always necessary for infectious colitis, particularly in mild cases of certain bacterial infections which may resolve spontaneously 1.
• Antibiotics can sometimes worsen colitis by disrupting the gut microbiome, so they should be used judiciously 1.
• Supportive care with hydration and electrolyte replacement is essential regardless of antibiotic therapy 1.
• Fecal microbiota transplantation (FMT) is an effective option for patients with multiple CDI recurrences who have failed appropriate antibiotic treatments 1.
• Coadjuvant treatment with monoclonal antibodies (bezlotoxumab) may prevent recurrences of CDI, particularly in patients with CDI due to the 027 epidemic strain, in immunocompromised patients and in patients with severe CDI 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

The antibiotics that can be used for infectious colitis are:

• Vancomycin for C. difficile-associated diarrhea and staphylococcal enterocolitis 2

From the Research

Antibiotics for Infectious Colitis

• The following antibiotics can be used for infectious colitis:
  • Azithromycin: 1000mg in a single dose for empiric treatment of febrile dysenteric diarrhea invasive bacterial enteropathogens (Shigella, Salmonella, and Campylobacter) 3
  • Metronidazole: for the treatment of Clostridioides difficile infection (CDI) 4, 5
  • Vancomycin: for the treatment of CDI 4, 5, 6
  • Fidaxomicin: for the treatment of CDI, with superior global cure rates and lower recurrence rates compared to vancomycin 4, 5, 6

Specific Pathogen-Specific Antimicrobial Therapy

• Pathogen-specific antimicrobial therapy should be initiated for all forms of infectious colitis other than STEC 3
• For STEC, no antimicrobial therapy is recommended 3

Treatment of Clostridioides difficile Infection (CDI)

• Fidaxomicin, vancomycin, and metronidazole are effective treatments for CDI 4, 5, 6
• Fidaxomicin has been shown to be superior to vancomycin and metronidazole in terms of global cure rates and recurrence rates 6