Infectious colitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Qasim Salau, M.B.B.S., FMCPaed [2]

Overview

The mainstay of treatment of infectious colitis is the administration of antimicrobials against the causative pathogen. In addition to antimicrobial therapy, general supportive measures is usually given to replace fluid and electrolytes and occasionally blood.

Medical Therapy

The mainstay of treatment of infectious colitis is the administration of antimicrobials against the causative pathogen. In addition to antimicrobial therapy, general supportive measures is usually given to replace fluid and electrolytes and occasionally blood.

Symptomatic Treatment

• Symptomatic treatment for infectious colitis involves the replacement of fluids to correct dehydration, preferably mixed with electrolytes to provide essential salts and some amount of nutrients. Antimotility therapy is generally not indicated and may even be deleterious in the treatment of infectious colitis.
• The following supportive measures/ advice can be given:
  • Fluid resuscitation (oral, if not IV)
  • Patients should be advised to do the following until symptoms subside:
  • Hydrate with liquids that are caffeine free
  • Avoid lactose
  • Eating fresh fruit

Pathogen Specific

• The mainstay of therapy is given antimicrobials against the specific identified pathogen.
• The specific antimicrobial treatment of infectious colitis depends on the pathogen causing infectious colitis as follows:

• Shigella spp.
• Campylobacter jejuni
• Clostridium difficile
• Escherichia coli
• Nontyphoidal Salmonella
• Entameoba histolytica
• Chlamydia trachomatis
• Cytomegalovirus
• Yersinia enterocolitica

CMV Colitis

Duration of therapy: 21–42 days or until signs and symptoms have resolved

• Preferred Regimen (1): Ganciclovir 5 mg/kg IV q12h, may switch to valganciclovir 900 mg PO q12h once the patient can absorb and tolerate PO therapy.
• Alternate Regimen (1): Foscarnet 60 mg/kg IV q8h or 90 mg/kg IV q12h for patients with treatment limiting toxicities to ganciclovir or with ganciclovir resistance OR
• Alternate Regimen (2): Oral valganciclovir may be used if symptoms are not severe enough to interfere with oral absorption OR
• Alternate Regimen (3): For mild cases: If ART can be initiated or optimized without delay, withholding CMV therapy may be considered.
  • Note (1): Maintenance therapy is usually not necessary, but should be considered after relapses.