Colitis

Low Risk

•  Normal BP and pulse
• Body temperature <37°C
• Weight loss <2kg
• No anemia (Hb >9g/dl) or drop of Hb by >2g/dl as compared to previous value)
• No or minor abdominal discomfort
• Normal kidney function (CrCl >40 ml/min)
• No other indications of severity or comorbidities that increase the risk for complications (e.g. diabetes mellitus, cardiopathy)

Treat ambulatory

Initiate oral methylprednisolone at a dose of 2x 32 mg per day, start first dose in hospital.
Initiate oral antibiotics (e.g. ciproxin 250 mg BID) in case of suspected infectious origin and adapt according to result of coproculture

Medium Risk

• Low BP (<100/60) and tachycardia (>100/min)
• Body temperature >37°C
• Weight loss >2kg
• Anemia (Hb <9g/dl) or drop of Hb by >2g/dl (as compared to previous value)
• Moderate or severe abdominal pain
• Decreased kidney function (CrCl <40 ml/min)
• Other indications of severity or comorbidities that increase the risk for complications (e.g. diabetes mellitus, cardiopathy)

Hospitalize

• Perform CT-body and rectosigmoidoscopy.
• Check CMV on colon biopsy
• Start iv methylprednisolone at a dose of 125 mg iv 1x/day during 3 consecutive days.
• Control of H/C every day.
• Initiate oral antibiotics (e.g. ciproxin 250 mg BID) in case of suspected infectious origin and adapt according to result of coproculture.
• Manage dehydration, malnutrition and anemia according to standard practice.

High Risk

• Hemodynamic shock
• Severe abdominal pain suggestive of digestive perforation

Hospitalize

• Consult with abdominal surgeon and ICU physician
• Manage shock
• Perform CT-scan
• Start Solumedrol 125 mg iv 1x/day during 3 consecutive days
• Consider laparotomy in case of bowel perforation