eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology
Colitis: Treatment & Medication
Updated: Jun 17, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
The treatment of one cause of colitis, necrotizing enterocolitis (NEC), includes cessation of feedings, nasogastric decompression, and intravenous fluid resuscitation with attention to electrolytes and acid-base balance. Antibiotics should be started as soon as cultures are obtained. Close monitoring with cardiorespiratory support is provided as required. Exploratory laparotomy with resection of bowel and external ostomy diversion is indicated if there is failure of medical management, erythema of abdominal wall, a single fixed loop, a palpable mass, and/or evidence of perforation (eg, pneumoperitoneum, brown paracentesis). Central venous access is needed after bowel resection for total parenteral nutrition.4 Closely monitor the child for complications of short bowel syndrome and central catheters.- Treatment of allergic colitis consists of elimination of the offending protein from the infant's diet. Infants should receive a formula containing casein-hydrolysate as the protein source (eg, Nutramigen, Pregestimil, Alimentum). Mothers of exclusively breastfed infants with allergic colitis should eliminate the offending proteins (typically milk) from their diets. Persistence of gross bleeding after 14 days following a formula change is an indication for proctosigmoidoscopy. Infants with response to diet change should be challenged around their first birthday.
- Treatment of a child with pseudomembranous colitis depends on the severity of disease. Mild cases require cessation of antibiotics and supportive therapy with fluids and electrolytes. Evaluate patients with severe or persistent antibiotic-associated colitis for C difficile toxin in the stool. The patient should be treated with oral metronidazole (30 mg/kg/d in 4 divided doses) or oral vancomycin (40 mg/kg/d in 4 divided doses).
- Management of bacterial colitis is somewhat controversial. Shigellosis stands alone as the only form of bacterial colitis for which antibiotics have proved efficacious.
- Antimicrobial therapy shortens the course of the illness and the duration of excretion of the organisms in the stool by alleviating the signs and symptoms and limiting the transmission of the disease. Trimethoprim-sulfamethoxazole (TMP-SMZ) is the initial drug of choice; fluoroquinolones and ceftriaxone are the alternatives.
- If Salmonella bacteremia is suspected, intravenous cefotaxime (200 mg/kg/d in 4 divided doses) or ceftriaxone (100 mg/kg/d in 2 divided doses) should be initiated. Alternative treatments include chloramphenicol (100 mg/kg/d in 4 divided doses) or, in adolescents, fluoroquinolones. TMP-SMZ is the drug of choice when oral treatment is indicated.
- In Yersinia enterocolitica, antibiotic therapy of intravenous gentamicin (5-7.5 mg/kg/d in 3 divided doses) is indicated in patients with persistent diarrhea or suspected sepsis. Alternative antibiotics may include chloramphenicol, colistin, and kanamycin.
- Campylobacter enteritis is usually self-limited. The organism is sensitive to erythromycin and ciprofloxacin, but antibiotic treatment has not been proved to decrease the duration of diarrhea.
- Treatment of amebic colitis includes metronidazole and iodoquinol or paromomycin.
- Please see the eMedicine articles, Crohn Disease and Ulcerative Colitis.
- Management of inflammatory bowel disease (IBD) depends on the severity of the disease at presentation and is intended to decrease the bowel inflammation, with the goal of eventual healing, managing complications, and preventing recurrence or worsening disease.
- The therapy includes pharmacotherapy, surgery, nutrition,5 supportive therapy, psychotherapy, and cancer screening.
- Medications used to treat IBD can be classified into six categories, as follows:
- Aminosalicylates (sulfasalazine, mesalamine)
- Corticosteroids (prednisone, budesonide)
- Immunomodulators (eg, azathioprine, 6-mercaptopurine)
- Antibiotics (eg, metronidazole, ciprofloxacin)
- Probiotics (Lactobacillus GG, Saccharomyces boulardii)
- Biological agents (eg, infliximab)6
- Children with mild manifestations can be treated as outpatients with arrangement for follow-up treatment with a gastroenterologist.
- The initial therapy for children with mild ulcerative colitis (UC) or Crohn disease (CD) is usually sulfasalazine, a 5-aminosalicylate drug (5-ASA) that is given alone or in combination with topical enemas (ie, corticosteroid, mesalamine) or corticosteroid foam. Adolescents may prefer the foam because of its ease of administration and reduced sensation of rectal distention and urgency.
- Patients with moderate and severe disease (fever, bloody stools, severe abdominal pains, anemia, hypoalbuminemia) require supportive treatment, often with intravenous hydration.
- Hospitalization is often indicated for management of acute disease with corticosteroids and or immunosuppressive agents.
- Intravenous methylprednisolone or hydrocortisone at a dose equivalent to 1-2 mg/kg/d of prednisone is recommended. The goal is to use steroids for a short period and change to a maintenance therapy as soon as possible.
- Maintenance therapy may require administration of 5-ASA or an immunomodulator, such as azathioprine or 6-mercaptopurine.
- Refractory patients with CD may need infliximab as a maintenance agent. Infliximab has been used in the treatment of severe CD, but experience with its use in severe UC is limited.
- If toxic megacolon is suspected, aggressive resuscitation with fluids and electrolytes is required.
- Begin a combination of broad-spectrum intravenous antibiotics, such as ampicillin (200 mg/kg/d), gentamicin (5-7.5 mg/kg/d), and clindamycin (40 mg/kg/d). Alternate therapy may include either ampicillin/sulbactam (Unasyn) or cefoxitin in combination with gentamicin.
- Medical treatment includes adequate nutritional intake and social and emotional support.
- Nutrition therapy may be primary or adjunctive in CD but is only adjunctive in UC. Elemental or polymeric formulas may affect remission in as many as 80% of patients with CD.
- No specific therapy is indicated for Henoch-Schönlein purpura (HSP). Steroids are used to treat severe abdominal pain or arthritis in selected patients.
Surgical Care
- Surgery is indicated in UC or CD if uncontrolled GI bleeding, bowel perforation, bowel obstruction, failure to respond to medical therapy, and unacceptable medical toxicity are present.
- Total colectomy may be indicated in UC when the patient has toxic megacolon or acute fulminant colitis or in selected severe forms when medical therapy (including the newest immunosuppressive agents, eg, tacrolimus, infliximab) has failed.7 In UC, colectomy usually is performed with the creation of a "pouch" from the distal ileum and is curative (see Ulcerative Colitis). As many as 40% of the children may develop the so-called "pouchitis" (inflammation of the pouch) within 1 year. This entity is of unclear origin, but typically responds quickly to a course of antimicrobial treatment. Recent evidence in adults suggests that prophylaxis with probiotics may be an effective preventative tool.
- In CD, surgery is not curative because recurrent disease at the site of surgery is common. In CD, segmental bowel resection is the most common procedure and usually involves the diseased terminal ileum and adjacent inflamed colon. Stricturoplasty should be considered if there is stenosed bowel segment without active inflammation.
- At times surgical resection is used to treat growth failure.
Consultations
- A surgical consultation is required in patients with suspected toxic megacolon, appendicitis, intestinal obstruction, fulminant colitis, or significant GI bleeding.
Diet
- See Medical Care.
Medication
Because the causes of colitis are multiple and quite diverse, medical treatment of colitis is based on the underlying diagnosis.
Anti-inflammatory agents
Corticosteroids and 5-aminosalicylic acid (5-ASA) derivatives are used to treat ulcerative colitis (UC). See the corresponding eMedicine articles for the specific underlying diagnoses.
Sulfasalazine (Azulfidine, EN-tabs)
Sulfonamide derivative conjugate of 5-ASA. Serves as a carrier for 5-ASA. Useful in the management of UC and acts locally in colon to decrease inflammatory response and systemically inhibit prostaglandin synthesis.
Adult
1 g PO tid/qid initially; followed by maintenance dose of 1.5-2 g/d PO divided q6h
Pediatric
<2 years: Contraindicated
>2 years:
Initial: 6.7-10 mg/kg PO q4h; alternatively, 10-15 mg/kg PO q6h or 13.3-20 mg/kg q8h; not to exceed 6 g/d
Maintenance: 50-75 mg/kg/d PO in 3-4 divided doses; not to exceed 2 g/d
Decreases effects of iron, digoxin, cyclosporine, and folic acid; conversely, increases effects of PO anticoagulants, PO hypoglycemic agents, and methotrexate; may alter platelets, caution with coadministration of drugs affecting coagulation
Documented hypersensitivity; hypersensitivity to drugs containing sulfa moiety (eg, thiazides, furosemide, sulfonylureas, salicylate) or any component; GI or GU obstruction; porphyria
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Pregnancy category D near term; caution in patients with renal (adjust dose) or hepatic impairment, blood dyscrasias, G-6-PD deficiency, fragile X chromosome associated with mental retardation, or urinary obstruction
Mesalamine (5-ASA, Asacol, Pentasa, Rowasa)
Used for mild-to-moderate UC. The active component of sulfasalazine used for IBD. Effects chemical mediators of inflammatory response, particularly prostaglandins and leukotrienes. Usual course of therapy in adults is 3-6 wk. Some patients may need concurrent rectal and PO therapy. PO products are formulated to release slowly throughout GI tract.
Adult
Capsules: 1 g PO qid
Tablets: 800 mg PO tid
Rectal suppository: Insert 1 PR bid, retain for 1-3 h
Retention enema: 60 mL (4 g) PR hs
Pediatric
Capsules: 50 mg/kg/d PO divided q6-12h
Tablets: 50 mg/kg/d PO divided q8-12h
Rectal: Not established
May decrease effect of digoxin; may alter platelets, caution with coadministration of drugs affecting coagulation
Documented hypersensitivity; hypersensitivity to salicylates
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Elderly persons may have difficulty administering and retaining rectal suppositories; caution in patients with renal or hepatic impairment
Hydrocortisone (Hydrocortone, Cortef)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Adult
15-240 mg PO q12h
Pediatric
1-5 mg/kg/d or 100 mg/m2/d PO divided q12-24h
Corticosteroid clearance may decrease with estrogens; may increase digitalis toxicity secondary to hypokalemia
Documented hypersensitivity; viral, fungal, or tubercular skin infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in hyperthyroidism, osteoporosis, peptic ulcer, cirrhosis, nonspecific UC, diabetes, and myasthenia gravis
Methylprednisolone (Adlone, Medrol, Solu-Medrol, Depo-Medrol, Depopred)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Adult
2-60 mg/d PO/IV/IM in 1-4 divided doses followed by gradual reduction to lowest level that can maintain clinical response
Pediatric
0.5-1.7 mg/kg/d or 5-25 mg/m2/d PO/IV/IM divided q6-12h
Coadministration with digoxin, may increase digitalis toxicity secondary to hypokalemia; estrogens may increase levels of methylprednisolone; phenobarbital, phenytoin, and rifampin may decrease levels of methylprednisolone (adjust dose); monitor patients for hypokalemia when taking medication concurrently with diuretics
Documented hypersensitivity; viral, fungal, or tubercular skin infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Hyperglycemia, edema, osteonecrosis, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, growth suppression, myopathy, and infections are possible complications of glucocorticoid use
Antidiarrheal agents
These agents are used in the treatment of diarrhea adjunctly with rehydration therapy to correct fluid and electrolyte depletion. Note that inhibition of peristaltic activity induced by opioidlike agents (eg, loperamide) is contraindicated in established infectious colitis.
Loperamide (Imodium)
Acts on intestinal muscles to inhibit peristalsis and slow intestinal motility. Prolongs movement of electrolytes and fluid through bowel and increases viscosity and loss of fluids and electrolytes. Also has a mild proabsorptive effect on Na and Cl on the epithelial cells.
Adult
4 mg PO initially; followed by 2 mg after each loose stool; not to exceed 16 mg/d
Pediatric
Initial:
2-6 years: 1 mg PO tid
6-8 years: 2 mg PO bid
8-12 years: 2 mg PO tid
Maintenance: 0.1 mg/kg PO after each loose stool; not to exceed initial dose
Chronic diarrhea: 0.08-0.24 mg/kg/d divided bid/tid; not to exceed 2 mg/dose
Phenothiazines, tricyclic antidepressants, and CNS depressants may increase toxicity
Documented hypersensitivity; diarrhea resulting from infections; pseudomembranous colitis
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Discontinue use if no clinical improvement in 48 h; because primarily metabolized in liver, monitor for CNS toxicity in patients with hepatic insufficiency; do not use if high fever or blood in stool coincides with diarrhea; caution in infectious diarrhea caused by organism penetrating intestinal wall
Antibiotics
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Trimethoprim
sulfamethoxazole (TMP-SMZ, Bactrim, Bactrim DS, Septra, Septra DS, Cotrim, Cotrim DS) - Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Antibacterial activity of TMP-SMZ includes common urinary tract pathogens, except Pseudomonas aeruginosa. Dose is based on trimethoprim component.
Adult
Mild-to-moderate infections: 6-10 mg/kg/d PO/IV divided q12h
Severe infections: 15-20 mg/kg/d PO/IV divided q8-12h for 14 d
Pediatric
<2 months: Contraindicated
>2 months: Mild-to-moderate infections: 6-10 mg/kg/d PO/IV divided q12h
Severe infections: 15-20 mg/kg/d PO/IV divided q8-12h for 14 d
May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases incidence of thrombocytopenia purpura in elderly persons; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase levels of zidovudine
Documented hypersensitivity; megaloblastic anemia caused byfolate deficiency; age <2 mo
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Do not use during last trimester of pregnancy due to potential toxicity to newborn (eg, jaundice, hemolytic anemia, kernicterus); discontinue at first appearance of rash or sign of adverse reaction; frequently obtain CBC counts; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, give 5-15 mg/d leucovorin); caution in folate deficiency (eg, long-term alcoholism, elderly persons, those receiving anticonvulsant therapy, individuals with malabsorption syndrome); hemolysis may occur in G-6-PDdeficiency; persons with AIDS may not tolerate or respond to TMP-SMZ; caution in renal or hepatic impairment (perform urinalyses adrenal function tests during therapy); give fluids to prevent crystalluria and stone formation
Ampicillin (Marcillin, Omnipen, Polycillin, Principen, Totacillin)
Bactericidal activity against susceptible organisms. Alternative to amoxicillin when unable to take medication PO.
Adult
250-500 mg PO q6h
0.5-1.5 g IM q4-6h
0.5-3 g IV q4-6h
Pediatric
50-100 mg/kg/d PO divided q4-6h; not to exceed 3 g/d
100-400 mg/kg/d IM/IV divided q4-6h; not to exceed 12 g/d
Probenecid and disulfiram elevate levels; allopurinol decreases effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal failure; evaluate rash and differentiate from hypersensitivity reaction
Ampicillin and sulbactam (Unasyn)
Drug combination of beta-lactamase inhibitor with ampicillin. Covers skin, enteric flora, and anaerobes. Not ideal for nosocomial pathogens.
Adult
1.5 (1 g ampicillin plus 0.5 g sulbactam) to 3 g (2 g ampicillin plus 1 g sulbactam) IV/IM q6-8h; not to exceed 4 g/d sulbactam or 8 g/d ampicillin
Pediatric
3 months-12 years: 100-200 mg ampicillin/kg/d (150-300 mg Unasyn) IV divided q6h
>12 years: Administer as in adults; not to exceed 4 g/d sulbactam or 8 g/d ampicillin
Probenecid and disulfiram elevate levels; allopurinol decreases effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal failure; evaluate rash and differentiate from hypersensitivity reaction
Gentamicin (Garamycin)
Aminoglycoside antibiotic for gram-negative coverage. Used in combination with an agent against gram-positive organisms and one that covers anaerobes.
Adult
3-6 mg/kg/d IV qd or divided; dosing regimens vary; adjust dose according to CrCl and changes in volume of distribution
Pediatric
<5 years: 2.5 mg/kg/dose IV/IM q8h
>5 years: 5-7.5 mg/kg/d divided q8h; not to exceed 300 mg/d; monitor as in adults
Coadministration with other aminoglycosides, cephalosporins, penicillins, and amphotericin B may increase nephrotoxicity; aminoglycosides enhance effects of neuromuscular blocking agents, thus prolonged respiratory depression may occur; coadministration with loop diuretics may increase auditory toxicity of aminoglycosides; possible irreversible hearing loss of varying degrees may occur (monitor regularly)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Narrow therapeutic index (not intended for long-term therapy); caution in renal failure (not on dialysis) and adjust dose, myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission; monitor each regimen by at least a trough level drawn 30 min before the fourth dose; may draw a peak level 30 min after 30 min infusion
Metronidazole (Flagyl, Protostat)
Imidazole ring-based antibiotic active against various anaerobic bacteria and protozoa. Used in combination with other antimicrobial agents (except for C difficile enterocolitis).
Adult
250-500 mg PO tid/qid
Loading dose: 15 mg/kg or 1 g for 70-kg adult IV over 1 h
Maintenance dose: 6 h following loading dose; infuse 7.5 mg/kg or 500 mg IV for 70-kg adult over 1 h q6-8h; not to exceed 4 g/d
Pediatric
Infants and children:
Oral: 30 mg/kg/d PO divided q6-8h
Intravenous: Administer as in adults using body weight
May increase toxicity of anticoagulants, lithium, and phenytoin; cimetidine may increase toxicity; disulfiramlike reaction may occur with PO ingested ethanol
Documented hypersensitivity; first trimester of pregnancy
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in hepatic disease and severe renal dysfunction; monitor for seizures and development of peripheral neuropathy
Cefoxitin (Mefoxin)
Second-generation cephalosporin indicated for gram-positive cocci and gram-negative rod infections.
Adult
1-2 g IV q6-8h
Pediatric
Infants and children: 80-160 mg/kg/d IV divided q4-6h; higher doses for severe or serious infections; not to exceed 12 g/d
Probenecid may increase effects; coadministration with aminoglycosides or furosemide may increase nephrotoxicity (closely monitor renal function)
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged use or repeated treatment; caution in patients with previously diagnosed colitis
Ceftriaxone (Rocephin)
Third-generation cephalosporin with broad-spectrum gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin binding proteins.
Adult
1-2 g IV q12-24h; not to exceed 4 g/d
Pediatric
Neonates > 7 d: 25-50 mg/kg/d IV/IM; not to exceed 125 mg/d
Infants and children: 50-75 mg/kg/d IV/IM divided q12h; not to exceed 2 g/d
Probenecid may increase levels; coadministration with ethacrynic acid, furosemide, and aminoglycosides may increase nephrotoxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment; caution in breastfeeding women and allergy to penicillin
Cefotaxime (Claforan)
For septicemia and treatment of susceptible organisms. Arrests bacterial cell wall synthesis, which, in turn, inhibits bacterial growth. Third-generation cephalosporin with gram-negative spectrum. Lower efficacy against gram-positive organisms.
Adult
1-2 g IV/IM q4-8h; not to exceed 12 g/d
Pediatric
Infants and children: 200 mg/kg/d IV/IM divided q6-8h
>12 years or >50 kg: Administer as in adults
Probenecid may increase levels; coadministration with furosemide and aminoglycosides may increase nephrotoxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in severe renal impairment; has been associated with severe colitis
Chloramphenicol (Chloromycetin)
Binds to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. Effective against gram-negative and gram-positive bacteria.
Adult
50-100 mg/kg/d PO/IV divided q6h for 10 d; not to exceed 4 g/d
Pediatric
>3 months: 50-75 mg/kg/d PO/IV divided q6h; not to exceed 4 g/d
When administered concurrently with barbiturates, chloramphenicol serum levels may decrease while barbiturate levels may increase, causing toxicity; manifestations of hypoglycemia may occur with sulfonylureas; rifampin may reduce serum levels, presumably through hepatic enzyme induction; may increase effects of anticoagulants; may increase serum hydantoin levels, possibly resulting in toxicity; levels may be increased or decreased
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Pregnancy category D near term; use only for indicated infections, or as prophylaxis for bacterial infections; serious and fatal blood dyscrasias (eg, aplastic anemia, hypoplastic anemia, thrombocytopenia, granulocytopenia) can occur; evaluate baseline and perform periodic blood studies approximately every 2 d while in therapy; discontinue upon appearance of reticulocytopenia, leukopenia, thrombocytopenia, anemia, or findings attributable to chloramphenicol; adjust dose in liver or kidney dysfunction; caution in pregnancy at term or during labor because of potential toxic effects on fetus (ie, gray baby syndrome)
Vancomycin (Lyphocin, Vancocin, Vancoled)
Potent antibiotic directed against gram-positive organisms and active against Enterococcus species. Useful in the treatment of septicemia and skin structure infections. Indicated for patients unable to receive or have failed to respond to penicillins and cephalosporins or have infections with resistant staphylococci. For abdominal penetrating injuries, is combined with an agent active against enteric flora and/or anaerobes. To avoid toxicity, current recommendation is to assay vancomycin trough levels 30 min before fourth dose. Use CrCl to adjust dose in patients with renal impairment.
Adult
0.5-2 g/d PO divided q6-8h for 7-10 d
Pediatric
40 mg/kg/d PO divided q6-8h for 7-10 d; not to exceed 2 g/d
Erythema, histaminelike flushing and anaphylactic reactions may occur when administered with anesthetic agents; taken concurrently with aminoglycosides, risk of nephrotoxicity may increase above that with aminoglycoside monotherapy; effects in neuromuscular blockade may be enhanced, when coadministered with nondepolarizing muscle relaxants
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in renal failure; neutropenia; red man syndrome is caused by too rapid IV infusion (not an allergic reaction) but rarely occurs when dose is given over 2 h or as PO or IP administration
More on Colitis |
| Overview: Colitis |
| Differential Diagnoses & Workup: Colitis |
 Treatment & Medication: Colitis |
| Follow-up: Colitis |
| Multimedia: Colitis |
| References |
| Further Reading |
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Further Reading
- Relevant clinical guidelines include the following:
- Practice parameters for the surgical treatment of ulcerative colitis. 9
- Evidence-based care guideline for management of pediatric moderate/severe inflammatory bowel disease (IBD) 10
- American Gastroenterological Association Institute medical position statement on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease 11
- Relevant clinical trials include the following
- Efficacy Study of Granulocytapheresis Plus Steroids vs Steroids Alone in Active Steroid Dependent Ulcerative Colitis (ATICCA)
- (CB-01-02/01) Randomized Placebo Controlled Trial of Budesonide-MMX™ (CB-01-02) 6 mg and 9 mg in Patients With Ulcerative Colitis
- Immune Regulation in Ulcerative Colitis or Crohn's Disease
- Related eMedicine topics include the following
- Ulcerative Colitis (Pediatrics: General Medicine)
- Ulcerative Colitis (Radiology)
- Necrotizing Enterocolitis (Radiology)
- Colitis, Ischemic (Radiology)
- Ulcerative Colitis, Surgical Treatment (Pediatrics: Surgery)
- Necrotizing Enterocolitis, Surgical Treatment (Pediatrics: Surgery)
Keywords
colitis, inflammatory bowel disease, IBD, Crohn disease, CD, ulcerative colitis, UC, necrotizing enterocolitis, NEC, allergic colitis, pseudomembranous colitis, infectious colitis, parasitic colitis, ischemic colitis, bowel perforation, sepsis, diarrhea, uveitis, erythema nodosum, cholangitis, hepatitis, arthritis, abdominal distention, emesis, growth failure, weight loss, abdominal pain, iron deficiency anemia, juvenile rheumatoid arthritis, dysentery, disseminated intravascular coagulation, toxic megacolon, liver abscess, colonic perforation, proteinuria, hypertension, treatment, diagnosis
