Tuesday, January 31, 2023

Can Colitis Be Treated With Antibiotics

What Causes Colitis In Dogs

Treating IBD: Antibiotics

As previously mentioned, colitis can sometimes seem like a generic, catch-all diagnosis because the it can cause various conditions. Common causes of colitis can be intestinal parasites , bacterial infections , viral infections , Irritable Bowel Disease, dietary indiscretion, pancreatitis, stress, foreign bodies within the gastrointestinal tract, secondary to antibiotics, and even bowel cancer.

Suppurative Complications: Abscesses And Fistulas

Treatment of abdominal and anorectal abscesses consists of surgical or percutaneous drainage combined with antibiotic therapy. Small abscesses can be treated with antibiotics alone, especially in cases without associated fistulas or in immunomodulator-naive patients. Antibiotics should cover gram negative bacteria and anaerobes. A combination of fluoroquinolones or cephalosporins and metronidazole is considered appropriate.

Prevention Is Key For Stopping Canine Colitis

For the average dog owner, it is much smarter to focus on the prevention end of the spectrum than the treatment end. Fortunately, there are a number of strategies you can employ to help prevent your dog from dealing with colitis.

None are foolproof, but they will help improve your pups chances of having problem-free poops.

Keep your dogs stress level low. Stress is one of the most common causes of colitis, so do your best to keep your dog happy and well-exercised. Ensure he gets plenty of attention and affection, and that he has a safe place to which he can retreat whenever he likes.

Keep your dogs food and water dish clean. Dirty food and water dishes can serve as a buffet for bacteria. Given your dogs intimate relationship with these items, it makes good sense to wash his dishes daily. Dont forget to wash any other items that contact your pets food, such as the scoop you keep in the food bag.

Avoid wet, filthy areas when playing outside with your pup. Bacteria, fungi, viruses and parasites all lurk in wet, dirty areas like mud puddles and debris piles. While outdoor time neednt be a sterile activity, it is wise to avoid obviously sketchy areas.

Avoid allowing your dog contact with sick dogs. Some infections are communicable, meaning that your dog could catch them from other dogs. This doesnt mean that you shouldnt let your dog play with other dogs, but keep an eye out for dogs exhibiting tummy troubles, and steer your dog clear of them.

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You May Need More Than One Treatment To Keep You In Remission

Everyone responds differently to UC treatments.

Some people will need more than one drug to manage their symptoms. For example, your doctor might prescribe both a biologic and an immunosuppressant medication.

Adding on another drug can increase the effectiveness of your treatment. But taking more than one medication can also increase the number of side effects you experience.

Your doctor will balance your need for symptom control with possible risks of treatment when choosing a medication for you.

40 to 60 percent of people with UC who use mesalamine, thiopurines, and anti-tumor necrosis factor antibodies will have remission that lasts for a year.

If a drug leads to remission, the person will continue to take it. If they stop, the symptoms may return.

Colitis And The Anatomy Of The Colon

Ulcerative colitis: Medications and treatments

The colon, or large intestine, is a hollow, muscular tube that processes waste products of digestion from the small intestine, removes water, and ultimately eliminates the remnants as feces through the anus. The colon is located within the peritoneum, the sac that contains the intestine, located in the abdominal cavity.

The colon is surrounded by many layers of tissue. The innermost layer of the colon is the mucosa that comes into contact with the waste products of digestion. The mucosa absorbs water and electrolytes back into the blood vessels that are located just below the surface in the submucosa. This is surrounded by a circular layer of muscles and then another outer layer of longitudinal muscles that run along the length of the colon. The muscles work together to rhythmically squeeze liquid waste from the cecum through the entire length of the colon. Water is gradually removed, turning the waste into the formed stool so that it is excreted out of the anus in solid form.

The colon frames the organs within the peritoneum, and its segments are named based on their location.

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Is There A Colitis Diet

  • A clear fluid diet may be the best way to treat the diarrhea associated with colitis. Clear fluids are absorbed in the stomach and no waste products are delivered to the colon, allowing it to rest. Clear fluids without carbonation include anything that one can see through, and also includes popsicles and Jell-O.
  • Depending up on the cause of colitis, there may be some foods that can be tolerated and others that make the symptoms worse or produce âflares.â Keep a food diary to help identify and eliminate trigger foods, and identify and eat more foods that soothe or calm the colon.
  • Individuals with certain food intolerance may need to avoid whole groups of foods. Those with lactose intolerance should not eat foods containing dairy products including milk, cheese, yogurt and ice cream. Those with celiac disease need to avoid gluten containing foods.
  • Individuals with inflammatory bowel disease may want to limit exposure to fatty, greasy and fried foods, high fiber foods , and dairy products.

Hydration

What Exams And Tests Diagnose Colitis

While unpleasant, the rectal examination is very important. Using a finger, the doctor feels inside the rectum, exploring for any masses or tumors. The color and consistency of stool can be evaluated, and if it is not grossly bloody, can be tested for occult blood .

Laboratory Tests

The history will assist the health-care professional decide the tests to order and what cultures would be appropriate. Blood tests help assess the stability of the patient, and also explore any potential issues associated with colitis.

  • A complete blood count will assess the red blood cell count, the white blood cell count, and the number of platelets.
  • The red blood cell count will help define the amount of bleeding.
  • White blood cell counts elevate when the body is undergoing physical , physiological, or emotional stress.
  • Platelets help blood to clot, so knowing the platelet number in a patient with bleeding may be useful.
  • Electrolyte abnormalities can occur with diarrhea. Low sodium and low potassium levels may occur and cause symptoms far removed from the initial colitis signs and symptoms.
  • Kidney function may be assessed by measuring the BUN and creatinine levels.
  • Erythrocyte sedimentation rate and C reactive protein are nonspecific test of inflammation in the body.
  • Stool samples may be collected for culture, looking for infection as the cause of colitis
  • Colonoscopy

    Imaging

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    Antibiotics In Inflammatory Bowel Diseases: Do We Know What Were Doing

    Oren Ledder1,2

    The Hebrew University of Jerusalem , , Israel

    Correspondence to:

    Abstract: Despite the revolution in inflammatory bowel disease treatment over the past two decades with the advent of biological therapies, there remains a substantial proportion of patients with inadequate or unsustained response to existent therapies. The overwhelming focus of IBD therapeutics has been targeting mucosal immunity, however with the developing evidence base pointing to the role of gut microbes in the inflammatory process, renewed focus should be placed on the impact of manipulating the microbiome in IBD management. This review provides an overview of the evidence implicating bacteria in the pathogenesis of gut inflammation in IBD and provides an overview of the evidence of antibiotics in IBD treatment. We also suggest a potential role of antibiotics in clinical practice based on available evidence and clinical experience.

    Keywords: Inflammatory bowel disease antibiotics

    Submitted Oct 11, 2018. Accepted for publication Nov 26, 2018.

    doi: 10.21037/tp.2018.11.02

    What Blood Tests And/or Stool Samples Diagnose Colitis

    Antibiotic associated colitis (Pseudomembranous colitis (Clostridium Difficile Colitis )))
    • Acomplete blood count measures hemoglobin and hematocrit, looking for anemia. If the red blood cell count is elevated, it may be due to dehydration, where total body water is decreased and the blood becomes concentrated.
    • The CBC also measures the white blood cell count, which may be elevated as the body responds to infection. However, an elevated white blood cell count does not necessarily equal infection, since elevation may be due to the body’s reaction to any stress or inflammation.
    • Electrolytes may be measured looking for changes in the sodium, potassium, chloride, and bicarbonate levels in the blood that help determine the severity of dehydration and loss of fluid.
    • Kidney function may be checked by measuring the BUN and creatinine levels this may be an important clue as well to the severity of dehydration.
    • Urinalysis may reveal dehydration if the specific gravity is elevated or if there are ketones present.
    • Blood tests for markers of inflammation may also be measured, including erythrocyte sedimentation rate and C-reactive protein . These are nonspecific tests that may help guide decision-making.
    • Stool samples may be collected for culture, searching for bacterial and parasitic infections as the cause of colitis. The stool may also be tested for blood.

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    What Are The Symptoms Of Pseudomembranous Colitis

    Symptoms of pseudomembranous colitis include:

    • Frequent watery diarrhea that is sometimes bloody
    • Pain and tenderness in the stomach
    • Cramping
    • Loss of appetite

    In more severe cases, can occur.

    Most people who have pseudomembranous colitis notice symptoms 5 to 10 days after starting treatment with antibiotics.

    Antibiotics And Ibd: The Evidence

    IBD is a diverse condition with response to treatment dependent on multiple interrelated variables. To assess antibiotics in IBD as a whole, or even overall in CD or UC independently, is overly simplistic and will not reflect the true effect in specific circumstances. Hence we have attempted to review the role of antibiotics in more specific scenarios.

    Evidence relating to efficacy of therapeutic interventions generally depends on a number of large, high quality randomized controlled trials . Due to the relatively low number of high quality studies in antibiotics, and the high variability in antibiotics trialed, treatment course and outcome measures, drawing firm conclusions remains difficult.

    Further complicating attempts at analysis of existent data is the potential diverse conclusions drawn from individual studies. For example, in the seminal Australian antibiotic RCT of anti-MAP combination therapy including over 200 patients followed for 3 years , the primary endpoint of prolonged relapse-free course out to 3 years was not met, however the antibiotic group had a higher 16-week remission rate , and a clear trend to lower 12 months and 24 months relapse rate . However, considering that the antibiotic course was specifically tailored to target MAP, concerns were raised regarding possible underdosing of antibiotics, lack of pre-treatment testing for MAP, and levels of antibiotic resistance, further casting a doubt on the applicability of the evidence .

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    What Is Pseudomembranous Colitis

    Pseudomembranous colitis is inflammation of the large intestine. In many cases, it occurs after taking antibiotics. Using antibiotics can cause the bacterium Clostridium difficile to grow and infect the lining of the intestine, which produces the inflammation. Certain antibiotics, like penicillin, clindamycin , the cephalosporins and the fluoroquinolones, make C. diff overgrowth more likely.

    Symptoms Of C Diff Colitis

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    Symptoms of C. difficile infection typically begin 5 to 10 days after starting antibiotics but may occur on the first day or up to 2 months later.

    Symptoms vary according to the degree of inflammation caused by the bacteria, ranging from slightly loose stools to bloody diarrhea, abdominal pain and cramping, and fever. Nausea and vomiting are rare.

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    Follow A Recommended Corticosteroid Dose

    Corticosteroids are common treatments for UC flare-ups. It is important that a person follows their exact dosage over time.

    Doctors may prescribe a higher dose that reduces gradually over time.

    This is because if a person takes too much of a corticosteroid over a long period, it can put them at a greater risk of a number of problems, including heart problems and mood disorders.

    It is important that a person gradually tapers off their use of corticosteroids. This is because instantly or rapidly stopping the course may harm their body.

    Evidence For Antibiotics In Crohns Disease

    Induction of remission in active CD

    Diverse RCTs have been performed utilizing different antibiotic combinations, varying treatment periods and with differing end-points. Studies have primarily assessed either specific anti-MAP therapy or non-specific broad spectrum antibiotics or antibiotic combinations. Overall the strongest signal by antibiotic type appears to be with clofazimine and rifamycins with macrolides failing to achieve convincing induction of remission .

    A review of the RCTs performed for induction of remission in CD reveals a significant confounding factor. All of these trials utilized clinical indices with clinical remission and relapse being the primary outcome measures . It is well established that a large component of clinical activity in CD is not necessarily related to inflammation, with irritable bowel syndrome , bacterial overgrowth and chronic pain syndromes all occurring with greater frequency than the general population. The role of antibiotics in treating IBS and bacterial overgrowth is also well supported . Hence it is unclear whether clinical outcomes reflects a direct effect on mucosal inflammation and disease progress, or treatment of secondary clinical manifestations of arguable importance to true mucosal response.

    Table 1

    Maintenance of remission

    Post-operative prophylaxis

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    You Dont Need To Change Your Diet Dramatically

    Theres no evidence that following a strict diet can put you into remission or keep you there. In fact, cutting out certain foods could prevent you from getting the nutrients you need to stay healthy.

    You may want to avoid certain foods like dairy products if they seem to aggravate your symptoms. However, talk with your doctor or a dietitian before making any major changes to your diet.

    What Causes Infectious Colitis

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    Infectious colitis is not to be confused with other types of colitis, such as ulcerative colitis. Ulcerative colitis is an inflammatory bowel disease, but its causes are normally due to infections from bacteria, viruses, parasites, or fungus. The term colitis refers to the main symptom, which is diarrhea.

    Infectious colitis is often linked with food poisoning, which is an infection of the stomach and rectum. The most common cause of a food poisoning type of infectious colitis is contaminated water, and it comes from a parasite called entamoeba histolytica. You can also experience sudden diarrhea after consuming food contaminated with bacteria. E-coli, salmonella, shigella, yersinia, or campylobacter are all bacterial intestinal infections.

    In recent years, you have likely heard the term C. difficile, or C. diff. Over the last few years, some hospitals and nursing homes have experienced C. diff outbreaks. While the bacterium clostridium difficile is present in our colon and is part of our normal intestinal flora, when it is destroyed by antibiotics, it can overgrow, releasing toxins that lead to inflammation in the colon.

    There are also situations where the cause of the infectious colitis is viral or fungal. Viral colitis is rare but can occur in people with low immunityfor instance, in those who are going through chemotherapy or fighting AIDS. Fungal colitis is much like a virusit happens mostly in cases where a person has a compromised immune system.

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    Symptoms Of Infectious Colitis

    Infectious colitis symptoms may vary slightly depending on the cause, but generally, an attack comes with the following:

    While nausea and vomiting are less common than some of the other symptoms, it can happen to people who have sensitive digestive systems to begin with. Those who experience frequent watery stools and vomiting find that they get dehydrated. In these situations, it doesnt take long to notice weight loss and there is often need for hospitalization so that fluids can be administered through intravenous.

    Some of the symptoms mentioned here may sound like a simple flu bugsomething many people tend to fluff off. If you experience symptoms such as persistent pain and bloating, it is important to see a doctor to get a proper diagnosis.

    Treatment Of C Diff Colitis

    • Stopping use of the antibiotics causing the colitis

    • Taking an antibiotic effective against C. difficile

    • In severe, recurring cases, a stool transplant

    If a person with C. difficileinduced colitis has diarrhea while taking antibiotics, the drugs are stopped immediately unless they are essential. After stopping the antibiotic, symptoms usually stop within 10 to 12 days. If the symptoms are severe or persist, people are usually given an antibiotic that is effective against C. difficile.

    Drugs that people sometimes take to slow the movement of the intestine and treat diarrhea are usually avoided. Such drugs may prolong the disorder by keeping the disease-causing toxin in contact with the large intestine.

    Most cases of C. difficileinduced colitis are treated with the antibiotic vancomycin, given by mouth. A relatively new antibiotic, fidaxomicin, appears to be quite effective and results in fewer recurrences of symptoms.

    Symptoms return in 15 to 20% of people with this disorder, typically within a few weeks of stopping treatment. The first time diarrhea returns, people are given another course of the same antibiotic. If diarrhea continues to return, they are usually given vancomycin for several weeks, sometimes followed by the antibiotic rifaximin. Fidaxomicin for 10 days is an alternative.

    Rarely, surgery is required. For example, surgical removal of the large intestine may be needed in severe cases as a lifesaving measure.

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    The Causes Of Colitis In Dogs

    Colitis may occur for any of several different reasons. Some of the most common causes include:

    • Stress Dogs that are forced to endure significant amounts of stress may develop colitis. This is probably one of the more common causes of the condition, but it is also one of the easier ones to address in most cases. Youll need to identify the cause of the stress first, but then you can take steps to eliminate the problem. Consider brushing up on your dog calming signals so that you can observe and assess what is stressing your poor pooch out!
    • Intestinal Parasites Roundworms, tapeworms, protozoans and other microorganisms can set up shop in your pets digestive tract, where they can cause damage. You may even see worms appear in your dogs poop. This is one of the reasons routine de-worming is advised by most vets.
    • Toxic or Otherwise Inappropriate Food Dogs that get into the trash or dig up something suspect from the back yard may end up suffering from colitis if they eat something extremely fatty, toxic or sharp.

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