From the Guidelines
For infectious colitis, the first-line antibiotic treatment is oral vancomycin 125 mg four times daily for 10 days, as recommended by the most recent guidelines 1. When considering the treatment options for infectious colitis, it's crucial to identify the causative pathogen to guide antibiotic selection.
- The ECCO guidelines on the prevention, diagnosis, and management of infections in inflammatory bowel disease provide a comprehensive approach to managing C. difficile colitis 1.
- For an initial episode of C. difficile colitis, the treatment options include vancomycin 125 mg orally four times daily, fidaxomicin 200 mg orally twice daily, or metronidazole 500 mg orally three times daily 1.
- In cases of fulminant colitis, characterized by hypotension, shock, ileus, or megacolon, vancomycin 500 mg four times daily is recommended, with consideration for rectal instillation of vancomycin in patients with ileus 1.
- For recurrent C. difficile infections, treatment options include vancomycin, fidaxomicin, or a prolonged tapered and pulsed vancomycin regimen 1.
- It's essential to note that supportive care with fluid and electrolyte replacement is crucial in managing infectious colitis, regardless of the antibiotic chosen 1.
- The choice of antibiotic should be guided by stool studies, including culture, ova and parasite examination, and C. difficile testing, to ensure appropriate treatment and minimize unnecessary antibiotic use 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 antibiotic to start for infectious colitis is Vancomycin, specifically for:
- C. difficile-associated diarrhea
- Staphylococcal enterocolitis caused by Staphylococcus aureus (including methicillin-resistant strains) 2
From the Research
Antibiotics for Infectious Colitis
The choice of antibiotics for infectious colitis depends on the suspected or confirmed pathogen.
- For empiric treatment of febrile dysenteric diarrhea, invasive bacterial enteropathogens (Shigella, Salmonella, and Campylobacter) should be suspected, and adults may be treated empirically with 1000mg azithromycin in a single dose 3.
- For Clostridium difficile infection, the antibiotics of choice are vancomycin, fidaxomicin, and metronidazole, though metronidazole is considered inferior 4.
- Vancomycin is recommended for the treatment of severe CDI, while metronidazole is the standard of care for nonsevere infection 5.
- Other antibiotics that have shown promise in treating CDI include rifaximin, rifalazil, fidaxomicin, nitazoxanide, tigecycline, and ramoplanin 6.
Specific Considerations
- For patients with ulcerative colitis and nonsevere CDI, treatment with a vancomycin-containing regimen may result in fewer readmissions and shorter lengths of stay compared to treatment with metronidazole alone 5.
- The goal of treatment in infectious colitis is to provide pathogen-specific antimicrobial therapy, and the choice of antibiotic should be guided by the results of stool culture and other diagnostic tests 3.