Medication Summary
Because the causes of colitis are multiple and quite diverse, medical treatment of colitis is based on the underlying diagnosis.
Anti-inflammatory Agents
Class Summary
Corticosteroids and 5-aminosalicylic acid (5-ASA) derivatives are used to treat ulcerative colitis (UC).
Sulfasalazine (Azulfidine, Azulfidine EN-tabs)
Sulfasalazine is a sulfonamide derivative conjugate of 5-ASA. It serves as a carrier for 5-ASA. Sulfasalazine is useful in the management of UC and acts locally in the colon to decrease the inflammatory response and systemically inhibit prostaglandin synthesis.
Mesalamine (5-ASA, Asacol, Pentasa, Rowasa, Lialda)
Mesalamine is used for mild-to-moderate UC. It is the active component of sulfasalazine. Mesalamine affects chemical mediators of the inflammatory response, particularly prostaglandins and leukotrienes. The usual course of therapy in adults lasts 3-6 weeks. Some patients may need concurrent rectal and oral therapy. Oral products are formulated to release slowly throughout the gastrointestinal (GI) tract.
Hydrocortisone (Solu-Cortef, Cortef)
Hydrocortisone decreases inflammation by suppressing the migration of polymorphonuclear leukocytes (PMNs) and reversing increased capillary permeability.
Methylprednisolone (Medrol, Solu-Medrol, Depo-Medrol)
Methylprednisolone decreases inflammation by suppressing the migration of PMNs and reversing increased capillary permeability.
Antidiarrheal agents
Class Summary
Antidiarrheal agents are used to treat diarrhea in conjunction 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)
Loperamide acts on intestinal muscles to inhibit peristalsis and slow intestinal motility. It prolongs the movement of electrolytes and fluid through the bowel and increases viscosity and loss of fluids and electrolytes. It also has a mild proabsorptive effect on sodium and chlorine in the epithelial cells.
Antibiotics
Class Summary
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Trimethoprim-sulfamethoxazole (Bactrim, Bactrim DS, Septra DS)
Trimethoprim-sulfamethoxazole (TMP-SMZ) inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. The antibacterial activity of TMP-SMZ includes common urinary tract pathogens, except for Pseudomonas aeruginosa. The dose is based on the trimethoprim component.
Ampicillin
Ampicillin has bactericidal activity against susceptible organisms. It is an alternative to amoxicillin when the patient is unable to take medication orally.
Ampicillin-sulbactam (Unasyn)
Ampicillin-sulbactam is a combination of a beta-lactamase inhibitor with ampicillin. It covers skin organisms, enteric flora, and anaerobes. It is not ideal for nosocomial pathogens.
Gentamicin
Gentamicin is an aminoglycoside antibiotic for gram-negative coverage. It is used in combination with an agent that covers gram-positive organisms and one that covers anaerobes.
Metronidazole (Flagyl, Flagyl ER)
Metronidazole is an imidazole ring-based antibiotic that is active against various anaerobic bacteria and protozoa. It is used in combination with other antimicrobial agents (except for C difficile enterocolitis).
Cefoxitin (Mefoxin)
Cefoxitin is a second-generation cephalosporin that is indicated for gram-positive cocci and gram-negative rod infections.
Ceftriaxone (Rocephin)
Ceftriaxone is a third-generation cephalosporin with broad-spectrum gram-negative activity; it has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. Ceftriaxone arrests bacterial growth by binding to 1 or more penicillin-binding proteins.
Cefotaxime (Claforan)
Cefotaxime is used for septicemia and treatment of susceptible organisms. It arrests bacterial cell wall synthesis, which, in turn, inhibits bacterial growth. Cefotaxime is a third-generation cephalosporin with a gram-negative spectrum of activity; it has lower efficacy against gram-positive organisms.
Chloramphenicol (Chloromycetin)
Chloramphenicol binds to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. It is effective against gram-negative and gram-positive bacteria.
Vancomycin (Vancocin)
Vancomycin is a potent antibiotic that is directed against gram-positive organisms and is active against Enterococcus species. It is useful in the treatment of septicemia and skin-structure infections. Vancomycin is indicated for patients who are unable to receive or have failed to respond to penicillins and cephalosporins or who have infections with resistant staphylococci. For abdominal penetrating injuries, it is combined with an agent active against enteric flora or anaerobes.
To prevent toxicity, the current recommendation is to assay vancomycin trough levels 30 minutes before the fourth dose. Use the creatinine clearance to adjust the dose in patients with renal impairment.
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Necrotizing enterocolitis totalis.
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Inflammatory bowel disease. Severe colitis noted during colonoscopy. The mucosa is grossly denuded, with active bleeding noted. This patient had her colon resected very shortly after this view was obtained.
