Proctitis and Anusitis Medication

Updated: Jun 08, 2017
  • Author: David E Stein, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Corticosteroids

Class Summary

These agents are the treatments of choice for an acute inflammatory bowel disease (IBD) attack; administer IV in severe disease. Administer increased or stress doses to patients already on steroids. Do not use steroids for maintaining remission because of their lack of efficacy and potential complications, including avascular necrosis, osteoporosis, cataracts, emotional lability, hypertension, diabetes mellitus, cushingoid features, acne, and facial hair. Cortenema, Cortifoam, and Anusol-HC suppositories are useful in treating distal disease (proctitis and proctosigmoiditis).

Budesonide (Entocort EC, Uceris)

Budesonide alters the level of inflammation in tissues by inhibiting multiple types of inflammatory cells and decreasing the production of cytokines and other mediators involved in inflammatory reactions.

Hydrocortisone (Cortenema, Anusol-HC, Proctocort, Proctocream HC, Proctosol HC)

Adrenocortical steroids act as potent inhibitors of inflammation. It may cause profound and varied metabolic effects, particularly in relation to salt, water, and glucose tolerance, in addition to their modification of the immune response of the body. Alternative adrenocortical steroids may be used in equivalent dosage.

Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol)

Adrenocortical steroids act as potent inhibitors of inflammation. They may cause profound and varied metabolic effects, particularly in relation to salt, water, and glucose tolerance, in addition to their modification of the immune response of the body. Alternative adrenocortical steroids may be used in equivalent dosage.

Dexamethasone (Dexamethasone Intensol)

Dexamethasone has many pharmacologic benefits, but also significant adverse effects. It stabilizes cell and lysosomal membranes, increases surfactant synthesis, and inhibits prostaglandin and proinflammatory cytokines.

Prednisone (Deltasone, Prednisone Intensol, Rayos)

Prednisone acts as a potent inhibitor of inflammation. It may cause profound and varied metabolic effects, particularly in relation to salt, water, and glucose tolerance, in addition to their modification of the immune response of the body. Alternative corticosteroids may be used in equivalent dosage.

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5-Aminosalicylic Acid Derivatives

Class Summary

These agents are effective in reducing inflammatory reactions. All of the aminosalicylates are useful for treating flares of IBD and for maintaining remission.

Sulfasalazine (Azulfidine, Azulfidine EN)

This agent is considered best for colonic disease, although it is also considered first-line therapy for Crohn disease. It is used for acute disease and for maintenance of remission.

Mesalamine (Apriso, Asacol HD, Delzicol, Pentasa, Rowasa)

Mesalamine is a 5-ASA and acts systemically. It also has activity as a topical anti-inflammatory.

Balsalazide (Colazal, Giazo)

Balsalazide is a prodrug 5-ASA connected to a 4-aminobenzoyl-(beta)-alanine carrier by an azo bond; colonic bacteria break the azo bond, releasing the active 5-ASA. Metabolites of the drug may decrease inflammation by blocking the production of arachidonic acid metabolites in colonic mucosa.

Olsalazine (Dipentum)

This aminosalicylate is useful for active disease and maintenance of remission in ulcerative colitis. Olsalazine is 5-ASA connected to a 5-ASA by an azo bond; colonic bacteria break the azo bond, releasing the active 5-ASA.

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Immunosuppressants

Class Summary

Agents in this class neutralize cytokine TNF-alpha and inhibit its binding to the TNF-alpha receptor.

Infliximab (Remicade)

Infliximab, given intravenously, consists of monoclonal antibodies to TNF-alpha. Approved by the FDA for use in IBD, in both Crohn disease and ulcerative colitis. Infliximab is somewhat more effective against CD than UC. The drug appears to promote mucosal healing. Furthermore, it heals perianal and enterocutaneous fistulae and has been shown to reduce signs and symptoms, achieve clinical remission, and eliminate corticosteroid use. Indicated for patients who have experienced inadequate response to conventional therapy.

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Antibiotics

Class Summary

Antimicrobial therapy must cover all likely pathogens in the context of the clinical setting. Antibiotics are used sparingly in persons with ulcerative colitis, because ulcerative colitis increases the risk of developing antibiotic-associated pseudomembranous colitis.

Ampicillin

Ampicillin, a broad-spectrum penicillin, interferes with bacterial cell-wall synthesis during active replication, causing bactericidal activity against susceptible organisms.

Ciprofloxacin (Cipro, Cipro XR)

Inhibits DNA gyrase and topoisomerase IV for bactericidal activity. Use as an alternative for MRSA infection.

Tetracycline

Tetracycline inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s). This agent treats gram-positive and gram-negative organisms and mycoplasmal, chlamydial, and rickettsial infections.

Doxycycline (Acticlate, Adoxa, Avidoxy, DoryxMonodox, Vibramycin)

Doxycycline inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Trimethoprim/sulfamethoxazole (Bactrim, Bactrim DS)

This combination agent inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Trimethoprim is a dihydrofolate reductase inhibitor that prevents tetrahydrofolic acid production in bacteria. It is active in vitro against a broad range of gram-positive and gram-negative bacteria, including uropathogens (eg, Enterobacteriaceae and Staphylococcus saprophyticus). Resistance is usually mediated by decreased cell permeability or alterations in amount or structure of dihydrofolate reductase. It demonstrates synergy with sulfonamides, potentiating inhibition of bacterial tetrahydrofolate production

Metronidazole (Flagyl, Flagyl ER, Metro)

Metronidazole is a widely available, inexpensive antibiotic and antiprotozoal agent. Inhibits protein synthesis and causes cell death in susceptible organisms by diffusing into the organism and causing a loss of helical DNA structure and strand breakage.

Rifaximin (Xifaxan)

Rifaximin is a nonabsorbed (<0.4%), broad-spectrum antibiotic specific for enteric pathogens of the gastrointestinal tract (ie, gram-positive, gram-negative, aerobic, anaerobic). It is a rifampin structural analog and it binds to the beta-subunit of bacterial DNA-dependent RNA polymerase, thereby inhibiting RNA synthesis.

Penicillin G benzathine (Bicillin LA)

Interferes with synthesis of cell wall mucopeptides during active multiplication, which results in bactericidal activity. Used to treat syphilis and for prophylaxis of recurrent streptococcal infections.

Vancomycin (Vancocin)

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.

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.

Gentamicin

Aminoglycoside antibiotic for gram-negative coverage. Used in combination with an agent against gram-positive organisms and one that covers anaerobes.

Cefixime (Suprax)

Potent long-acting oral cephalosporin with increased gram-negative coverage.

Ampicillin/sulbactam (Unasyn)

Drug combination of beta-lactamase inhibitor with ampicillin. Covers skin, enteric flora, and anaerobes. Not ideal for nosocomial pathogens.

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Amebicides

Class Summary

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.

Iodoquinol (Aloquin)

Amebicidal against E histolytica. Considered effective against trophozoite and cyst forms.Halogenated hydroxyquinoline. Luminal amebicide; acts primarily in bowel lumen because it is poorly absorbed. Best tolerated when given with meals. Because it is active only against intraluminal form of amebiasis, it is used to eradicate cysts of E histolytica after treatment of invasive disease.

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Antivirals, HSV

Class Summary

The goals of using antivirals are to shorten the clinical course, prevent complications, prevent development of latency and subsequent recurrences, decrease transmission, and eliminate established latency.

Acyclovir (Zovirax)

Acyclovir is the drug of choice for HSE. It has demonstrated inhibitory activity against both herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) and is taken up selectively by infected cells. Mortality from HSE before use of acyclovir was 60-70%; since acyclovir, it is approximately 30%.

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Gastrointestinal Agents, Other

Class Summary

Agents in this class protect the gastric lining against peptic acid.

Sucralfate (Carafate)

Sucralfate binds to positively charged proteins in exudates to form a complex, which is a viscous paste-like, adhesive substance. It forms a protective coating that acts locally to protect the gastric lining against peptic acid, pepsin, and bile salts.

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