From the Guidelines
For Clostridium difficile colitis, oral vancomycin (125 mg four times daily for 10-14 days) is recommended as first-line therapy, as it is considered superior to metronidazole in severe CDI 1. When considering the treatment of colitis, it's essential to identify the specific cause and type. For Clostridium difficile colitis, the choice of antibiotics is crucial.
- Oral vancomycin (125 mg four times daily for 10-14 days) is the preferred treatment for an initial episode of severe CDI, as well as for recurrent cases 1.
- Fidaxomicin (200 mg twice daily for 10 days) may be a valid alternative to vancomycin in patients with CDI, particularly for those at high risk of recurrence 1.
- Metronidazole (500 mg three times daily for 10-14 days) may be used for mild cases of CDI or when other options are not available, but its use should be limited to the treatment of an initial episode of mild-moderate CDI 1. It's also important to consider the severity of the disease and the patient's overall condition when selecting an antibiotic regimen.
- For severe cases, higher doses of vancomycin (up to 500 mg four times daily) may be necessary, although the evidence for this is limited 1.
- In cases of fulminant colitis, early surgical consultation and potential surgical intervention, such as resection of the entire colon or diverting loop ileostomy with colonic lavage, may be necessary 1. Treatment should always be accompanied by supportive care, including fluid replacement, electrolyte correction, and discontinuation of the inciting antibiotic if applicable.
- Probiotics may be considered following antibiotic therapy to restore gut flora, and fecal microbiota transplantation (FMT) may be an effective option for patients with multiple CDI recurrences who have failed appropriate antibiotic treatments 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 colitis is Vancomycin, specifically for C. difficile-associated diarrhea and Staphylococcal enterocolitis 2.
From the Research
Antibiotics for Colitis
- The choice of antibiotics for colitis depends on the severity and cause of the infection.
- For severe Clostridium difficile infection (CDI), oral vancomycin is recommended 3.
- For non-severe CDI, metronidazole is the standard of care, but vancomycin-containing regimens may be more effective in patients with ulcerative colitis (UC) 3.
- For empiric treatment of febrile dysenteric diarrhea, azithromycin may be used to treat invasive bacterial enteropathogens such as Shigella, Salmonella, and Campylobacter 4.
Treatment of Ulcerative Colitis
- The goals of treatment in UC are to improve quality of life, achieve steroid-free remission, and minimize the risk of cancer 5.
- Treatment options for UC include 5-aminosalicylic acid (5-ASA) drugs, corticosteroids, calcineurin inhibitors, and tumor necrosis factor-α antibodies 5, 6.
- The choice of treatment depends on disease extent, severity, and course 5, 6.
Approach to Infectious Colitis
- The management of acute colitis in adults depends on establishing the cause of the infection 7.
- Multiplex polymerase chain reaction (PCR) and guided culture can help confirm active infection and guide antibiotic therapy 7.
- Patients with colitis may require antimicrobial therapy, and the choice of antibiotics depends on the cause and severity of the infection 4, 7.