What oral antibiotics are used to treat colitis (inflammation of the colon)?

From the Guidelines

Oral vancomycin (125mg four times daily for 10 days) is the recommended treatment for Clostridium difficile colitis, as it has been shown to be superior to metronidazole in severe cases 1. For patients with mild-moderate CDI, metronidazole may be considered, but its use should be limited to the treatment of an initial episode 1. Fidaxomicin (200mg twice daily for 10 days) is also a valid alternative to vancomycin, particularly in patients who are at high risk for recurrence 1. It's essential to note that the choice of antibiotic therapy should be based on the severity of the disease and the specific cause of colitis. In cases of severe CDI, early surgical consultation should be considered, and resection of the entire colon or diverting loop ileostomy with colonic lavage may be necessary 1. Proper diagnosis through stool tests, colonoscopy, or imaging is crucial to determine the specific type of colitis and guide treatment decisions. Antibiotics should only be used when a bacterial cause is confirmed or strongly suspected, as inappropriate use can disrupt gut flora and potentially worsen colitis symptoms 1. In general, oral antibiotics like ciprofloxacin or metronidazole may be prescribed for infectious colitis caused by bacteria, but they are not effective for inflammatory bowel disease-related colitis like ulcerative colitis or Crohn's disease. Some key points to consider when treating colitis with oral antibiotics include:

• The importance of proper diagnosis to guide treatment decisions
• The need to consider the severity of the disease and the specific cause of colitis when choosing an antibiotic
• The potential risks of disrupting gut flora and worsening colitis symptoms with inappropriate antibiotic use
• The importance of consulting with a gastroenterologist for proper diagnosis and treatment of colitis. The most recent and highest quality study 1 provides the best guidance for treating Clostridium difficile colitis with oral antibiotics.

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 Vancomycin Hydrochloride Capsules for the treatment of colitis are for oral use only and are not systemically absorbed.

Oral antibiotics for colitis: Vancomycin Hydrochloride Capsules are indicated for the treatment of C. difficile-associated diarrhea and enterocolitis caused by Staphylococcus aureus. The recommended dose for C. difficile-associated diarrhea is 125 mg administered orally 4 times daily for 10 days. For staphylococcal enterocolitis, the total daily dosage is 500 mg to 2 g administered orally in 3 or 4 divided doses for 7 to 10 days 2.

From the Research

Oral Antibiotics for Colitis

• The use of oral antibiotics for colitis is a topic of interest in the medical field, with various studies examining their effectiveness in treating different types of colitis 3, 4, 5, 6.
• According to a study published in 2014, oral vancomycin is recommended for the treatment of severe Clostridium difficile infection (CDI), while metronidazole is the standard of care for non-severe infection 4.
• Another study published in 2021 suggests that most forms of infectious colitis are treatable with antimicrobials, and that multiplex polymerase chain reaction (PCR) followed by guided culture on PCR-positive pathogens can often confirm active infection 5.
• A meta-analysis and systematic review published in 2018 compared the efficacy of fidaxomicin and vancomycin for the treatment of a first episode of CDI, and found that fidaxomicin was associated with a significantly lower recurrence of CDI 6.
• However, it's worth noting that the use of oral antibiotics for colitis is not always straightforward, and the choice of treatment depends on the specific type and severity of the colitis, as well as the patient's individual needs and medical history 3, 7.

Types of Colitis

• Ulcerative colitis (UC) is a chronic idiopathic inflammatory bowel disorder of the colon that causes continuous mucosal inflammation extending from the rectum to the more proximal colon 3.
• Infectious colitis, on the other hand, is a type of colitis caused by an infection, and can be treated with antimicrobials 5.
• Clostridium difficile infection (CDI) is a type of infectious colitis that can be treated with oral vancomycin or fidaxomicin 4, 6.

Treatment Options

• The goals of treatment for UC are to improve quality of life, achieve steroid-free remission, and minimize the risk of cancer 3.
• Treatment options for UC include 5-aminosalicylates (5-ASAs), sulfasalazine (SASP), corticosteroids, and immunomodulatory drugs 3, 7.
• For infectious colitis, treatment options include antimicrobials such as vancomycin, metronidazole, and fidaxomicin 4, 5, 6.