What is the treatment for infectious colitis?

From the Guidelines

Treatment for infectious colitis should prioritize addressing the underlying cause while managing symptoms, with a focus on reducing morbidity, mortality, and improving quality of life. When considering the treatment for infectious colitis, it's essential to identify the causative pathogen and tailor the treatment accordingly.

• For bacterial colitis, antibiotics are the mainstay of treatment, with specific choices depending on the pathogen.
• For Clostridium difficile colitis, oral vancomycin 125mg four times daily for 10-14 days is a recommended treatment option 1.
• In severe cases of Clostridium difficile colitis, such as fulminant colitis, high-dose vancomycin (500 mg, 6 hourly), oral and/or by enema, in combination with intravenous metronidazole (500 mg, 8 hourly) may be considered 1.
• For viral colitis, treatment is primarily supportive with hydration and rest as the infection typically resolves on its own within days.
• Parasitic colitis requires antiparasitic medications; for example, metronidazole 500mg three times daily for 5-10 days treats Entamoeba histolytica. Regardless of the cause, maintaining hydration is crucial, using oral rehydration solutions or, in severe cases, intravenous fluids.
• Probiotics may help restore gut flora, particularly after antibiotic treatment.
• Antimotility agents like loperamide should be avoided in infectious colitis as they can prolong infection. Treatment effectiveness stems from eliminating the pathogen while supporting the body's natural healing processes and preventing complications like dehydration or electrolyte imbalances. In cases where the inciting antibiotic cannot be discontinued, antibiotic treatment for CDI should be initiated 1. It's also important to note that resection of the entire colon should be considered to treat patients with fulminant colitis 1. However, diverting loop ileostomy with colonic lavage may be a useful alternative to resection of the entire colon 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 treatment for infectious colitis with vancomycin (PO) is indicated for 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.
• The recommended dose for staphylococcal enterocolitis is 500 mg to 2 g administered orally in 3 or 4 divided doses for 7 to 10 days 2. Vancomycin Hydrochloride Capsules must be given orally for treatment of these infections.

From the Research

Treatment for Infectious Colitis

• The treatment for infectious colitis depends on the cause of the infection, with most forms being treatable with antimicrobials 3.
• For empiric treatment of febrile dysenteric diarrhea, invasive bacterial enteropathogens such as Shigella, Salmonella, and Campylobacter should be suspected, and adults may be treated empirically with 1000mg azithromycin in a single dose 4.
• Pathogen-specific antimicrobial therapy should be initiated for all forms of infectious colitis other than Shiga toxin-producing Escherichia coli (STEC) 4.
• Multiplex polymerase chain reaction (PCR) followed by guided culture on PCR-positive pathogens can often confirm active infection, while standard culture methods provide isolates for antibiotic susceptibility testing, subtyping, and Whole Genome Sequencing 3.

Specific Treatments

• For Clostridium difficile infection, fidaxomicin has been shown to be noninferior to vancomycin in terms of clinical cure, and is associated with a significantly lower rate of recurrence 5.
• For STEC, no antimicrobial therapy is recommended, as it may increase the risk of hemolytic uremic syndrome 4.

Diagnostic Approaches

• Standard stool culture should be performed in patients with infectious colitis, and epidemiologic findings may suggest the need for specialized studies of etiology 4.
• CT with intravenous contrast is the imaging modality of choice for ischaemic colitis, and can support clinical diagnosis, define the severity and distribution of ischaemia, and has prognostic value 6.
• Lower gastrointestinal endoscopy should be performed within 48 hours of diagnosis to reach the distal-most extent of the disease, providing endoscopic (and histological) confirmation 6.