From the Guidelines
The treatment plan for colitis inpatients should prioritize intravenous steroids, such as methylprednisolone 60 mg daily, as the initial recommended treatment for severe active ulcerative colitis, along with adequate intravenous fluids, low-molecular-weight heparin for thromboprophylaxis, and correction of electrolyte abnormalities and anemia if needed, as suggested by the most recent and highest quality study 1.
Key Components of Treatment
- Intravenous fluids for rehydration and electrolyte replacement
- Bowel rest
- Intravenous corticosteroids, such as methylprednisolone 60 mg daily, for moderate to severe cases
- Low-molecular-weight heparin for DVT prophylaxis
- Correction of electrolyte abnormalities and anemia if needed
- Daily monitoring of vital signs, abdominal examinations, and stool frequency
Management of Severe Cases
- For severe active ulcerative colitis, monotherapy with intravenous ciclosporin is an alternative, especially in cases of serious adverse events due to steroids 1
- Biologics like infliximab or vedolizumab may be necessary for steroid-refractory cases
- Immunomodulators such as azathioprine or 6-mercaptopurine can be added for maintenance
Additional Considerations
- Nutritional support is essential, and patients who are malnourished may require enteral or parenteral nutrition 1
- Pain management with acetaminophen is preferred over opioids, which can mask symptoms and worsen motility
- Surgery may be necessary for patients with toxic megacolon, perforation, or refractory disease
Monitoring and Assessment
- Daily monitoring of vital signs, abdominal examinations, and stool frequency is crucial
- Regular assessment of response and remission is critical to ensuring optimal outcomes 1
From the FDA Drug Label
2.3 Ulcerative Colitis The recommended dose of RENFLEXIS is 5 mg/kg given as an intravenous induction regimen at 0,2 and 6 weeks followed by a maintenance regimen of 5 mg/kg every 8 weeks thereafter for the treatment of adult patients with moderately to severely active ulcerative colitis. The treatment plan for ulcerative colitis inpatient is to administer 5 mg/kg of infliximab (IV) as an induction regimen at 0,2, and 6 weeks, followed by a maintenance regimen of 5 mg/kg every 8 weeks 2.
- Key points:
- Dose: 5 mg/kg
- Induction regimen: 0,2, and 6 weeks
- Maintenance regimen: every 8 weeks
- This treatment plan is for adult patients with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy.
From the Research
Treatment Plan for Colitis Inpatient
The treatment plan for colitis inpatient involves a multidisciplinary approach, including gastroenterologists and surgeons, to manage the disease and prevent complications 3, 4, 5, 6. The goal of treatment is to rapidly induce a steroid-free remission while preventing complications of the disease itself and its treatment.
Medical Treatment
- The choice of treatment depends on the severity, localization, and course of the disease 4, 7.
- For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used as the first-line treatment 4, 7.
- More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission 4, 7.
- Patients who do not respond to initial intravenous corticosteroid may require rescue medical therapy, such as calcineurin inhibitors (cyclosporine, tacrolimus) or tumor necrosis factor-α antibodies (infliximab) 4, 6, 7.
Surgical Treatment
- Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding 4, 6, 7.
- Early involvement of the colorectal surgeon in the management of hospitalized ulcerative colitis patients is advocated to identify patients who are likely to undergo surgery and to not prolong ineffective medical treatment 3, 5, 6.
- A staged proctocolectomy may be considered as one of the therapeutic options for patients who do not respond to medical treatment 6.
Monitoring and Follow-up
- Patients should be closely monitored for the possible development of toxic megacolon or perforation, which should prompt emergency colectomy 3, 5.
- The Mayo scoring system is a commonly used index to assess disease severity and monitor patients during therapy 7.
- A coordinated multidisciplinary, individualized approach to treatment, involving patient preferences throughout the process, is optimal in providing patient-centered effective care 6.