From the Guidelines
The treatment plan for infectious colitis in an inpatient setting should prioritize identifying and addressing the causative pathogen, with a focus on C. difficile colitis, using oral vancomycin 125mg four times daily for 10-14 days as the first-line treatment, as recommended by the most recent guidelines 1. Inpatient management of infectious colitis involves a comprehensive approach that includes:
- Fluid and electrolyte replacement with intravenous normal saline or lactated Ringer's solution to correct dehydration
- Identification of the causative pathogen and initiation of targeted antibiotic therapy
- For C. difficile colitis, oral vancomycin 125mg four times daily for 10-14 days is the recommended treatment, with metronidazole 500mg three times daily for 10-14 days as an alternative for mild cases 1
- Supportive measures, such as anti-diarrheal agents like loperamide, pain management with acetaminophen or opioids, and nutritional support with clear liquids and a low-residue diet
- Isolation precautions, including contact precautions for C. difficile and droplet precautions for norovirus In cases of fulminant colitis, early diagnosis and treatment with high-dose vancomycin (500 mg, 6 hourly) and intravenous metronidazole (500 mg, 8 hourly) is crucial, with consideration of surgical intervention, such as total colectomy or diverting loop ileostomy with antegrade colonic lavage, in severe cases 1. Key considerations in the treatment of infectious colitis include:
- Early recognition and treatment of C. difficile colitis to reduce morbidity and mortality
- Use of targeted antibiotic therapy based on suspected pathogens and local resistance patterns
- Implementation of supportive measures to manage symptoms and prevent complications
- Adherence to isolation precautions to prevent transmission of infectious agents.
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 recommended dose is 125 mg administered orally 4 times daily for 10 days. Total daily dosage is 500 mg to 2 g administered orally in 3 or 4 divided doses for 7 to 10 days.
The treatment plan for infectious colitis inpatient using vancomycin (PO) is:
- C. difficile-associated diarrhea: 125 mg orally 4 times daily for 10 days 2
- Staphylococcal enterocolitis: 500 mg to 2 g orally in 3 or 4 divided doses for 7 to 10 days 2 Key considerations:
- Vancomycin Hydrochloride Capsules must be given orally for treatment of staphylococcal enterocolitis and Clostridium difficile-associated diarrhea 2
- Monitoring of serum concentrations of vancomycin may be appropriate in some instances, e.g., in patients with renal insufficiency and/or colitis or in those receiving concomitant therapy with an aminoglycoside antibiotic 2 2
From the Research
Treatment Plan for Infectious Colitis Inpatient
The treatment plan for infectious colitis inpatients involves a combination of supportive care, antimicrobial therapy, and in some cases, surgical intervention.
- For patients with Clostridium difficile colitis, intracolonic vancomycin (ICV) enema protocol has been shown to be effective in achieving complete resolution without surgery in 70% of patients 3.
- Oral vancomycin is also considered an effective treatment for antibiotic-associated Clostridium difficile colitis, with a lower dosage of 125 mg given three or four times a day being as effective as a higher dosage of 500 mg 4.
- For patients with acute severe ulcerative colitis (ASUC), inpatient management involves intravenous corticosteroid treatment and rescue therapy with infliximab or cyclosporine if needed 5.
- The approach to the patient with infectious colitis involves evaluation and treatment based on the suspected pathogen, with standard stool culture and epidemiologic findings guiding the diagnosis and treatment 6, 7.
- Empiric treatment with antimicrobials such as azithromycin may be initiated for febrile dysenteric diarrhea suspected to be caused by invasive bacterial enteropathogens 6.
- Multiplex polymerase chain reaction (PCR) followed by guided culture on PCR-positive pathogens can often confirm active infection and guide antimicrobial therapy 7.