Infectious colitis medical therapy: Difference between revisions
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{{CMG}}; {{AE}}{{QS}} | {{CMG}}; {{AE}}{{QS}} | ||
==Overview== | ==Overview== | ||
The mainstay of treatment of infectious colitis is the administration of [[antimicrobial]]s against the causative pathogen. In addition to antimicrobial therapy, general supportive measures is usually given to replace fluid and electrolytes and occasionally blood. | The mainstay of treatment of infectious colitis is the administration of [[antimicrobial]]s against the causative pathogen. In addition to antimicrobial therapy, general supportive measures is usually given to replace fluid and [[Electrolyte|electrolytes]] and occasionally [[blood]]. | ||
==Medical Therapy== | ==Medical Therapy== | ||
The mainstay of treatment of infectious colitis is the administration of [[antimicrobial]]s against the causative pathogen. In addition to antimicrobial therapy, general supportive measures is usually given to replace fluid and electrolytes and occasionally blood. | The mainstay of treatment of infectious colitis is the administration of [[antimicrobial]]s against the causative pathogen. In addition to antimicrobial therapy, general supportive measures is usually given to replace fluid and [[Electrolyte|electrolytes]] and occasionally [[blood]]. | ||
===Symptomatic Treatment=== | ===Symptomatic Treatment=== | ||
* Symptomatic treatment for infectious colitis involves the | * Symptomatic treatment for infectious colitis involves the replacement of fluids to correct dehydration, preferably mixed with [[electrolyte]]s to provide essential [[salt]]s and some amount of [[nutrient]]s. Antimotility therapy is generally not indicated and may even be deleterious in the treatment of infectious colitis.<ref name="pmid22080825">{{cite journal| author=DuPont HL| title=Approach to the patient with infectious colitis. | journal=Curr Opin Gastroenterol | year= 2012 | volume= 28 | issue= 1 | pages= 39-46 | pmid=22080825 | doi=10.1097/MOG.0b013e32834d3208 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22080825 }} </ref><ref name="pmid11170940">{{cite journal| author=Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV et al.| title=Practice guidelines for the management of infectious diarrhea. | journal=Clin Infect Dis | year= 2001 | volume= 32 | issue= 3 | pages= 331-51 | pmid=11170940 | doi=10.1086/318514 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11170940 }} </ref> | ||
*The following supportive measures/ advice can be given: | *The following supportive measures/ advice can be given: | ||
** Fluid resuscitation (oral, if not IV) | ** [[Fluid resuscitation]] (oral, if not IV) | ||
**Patients should be advised to do the following until symptoms subside: | **Patients should be advised to do the following until symptoms subside: | ||
**Hydrate with liquids that are [[caffeine]] free | **Hydrate with liquids that are [[caffeine]] free | ||
| Line 17: | Line 17: | ||
**Eating fresh fruit | **Eating fresh fruit | ||
===Pathogen Specific=== | ===Pathogen Specific=== | ||
*The mainstay of therapy is given antimicrobials against the specific identified pathogen.<ref name="pmid22080825">{{cite journal| author=DuPont HL| title=Approach to the patient with infectious colitis. | journal=Curr Opin Gastroenterol | year= 2012 | volume= 28 | issue= 1 | pages= 39-46 | pmid=22080825 | doi=10.1097/MOG.0b013e32834d3208 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22080825 }} </ref><ref name="pmid11170940">{{cite journal| author=Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV et al.| title=Practice guidelines for the management of infectious diarrhea. | journal=Clin Infect Dis | year= 2001 | volume= 32 | issue= 3 | pages= 331-51 | pmid=11170940 | doi=10.1086/318514 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11170940 }} </ref> | *The mainstay of therapy is given [[antimicrobials]] against the specific identified pathogen.<ref name="pmid22080825">{{cite journal| author=DuPont HL| title=Approach to the patient with infectious colitis. | journal=Curr Opin Gastroenterol | year= 2012 | volume= 28 | issue= 1 | pages= 39-46 | pmid=22080825 | doi=10.1097/MOG.0b013e32834d3208 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22080825 }} </ref><ref name="pmid11170940">{{cite journal| author=Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV et al.| title=Practice guidelines for the management of infectious diarrhea. | journal=Clin Infect Dis | year= 2001 | volume= 32 | issue= 3 | pages= 331-51 | pmid=11170940 | doi=10.1086/318514 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11170940 }} </ref> | ||
*The specific antimicrobial treatment of infectious colitis depends on the pathogen causing infectious colitis as follows: | *The specific antimicrobial treatment of infectious colitis depends on the [[pathogen]] causing infectious colitis as follows: | ||
*[[Shigellosis medical therapy|''Shigella spp.'']] | *[[Shigellosis medical therapy|''Shigella spp.'']] | ||
| Line 31: | Line 31: | ||
===CMV Colitis=== | ===CMV Colitis=== | ||
Duration of therapy: 21–42 days or until signs and symptoms have resolved | 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. | *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 (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 (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. | *Alternate Regimen (3): For mild cases: If [[HIV AIDS medical therapy|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. | **Note (1): Maintenance therapy is usually not necessary, but should be considered after relapses. | ||
Revision as of 16:00, 2 February 2018
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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.[1][2]
- 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.[1][2]
- 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.
References
- ↑ 1.0 1.1 DuPont HL (2012). "Approach to the patient with infectious colitis". Curr Opin Gastroenterol. 28 (1): 39–46. doi:10.1097/MOG.0b013e32834d3208. PMID 22080825.
- ↑ 2.0 2.1 Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV; et al. (2001). "Practice guidelines for the management of infectious diarrhea". Clin Infect Dis. 32 (3): 331–51. doi:10.1086/318514. PMID 11170940.