Inpatient Clinical Pathway for Assessment and Management
of Children with Acute Severe/Fulminant Ulcerative Colitis
Treatment Considerations
- PUCAI Daily
- Assess Severity
- Flexible sigmoidoscopy
- Exclude infection (CMV, C. difficile)
- Assess severity of colitis
- Risk of full colonoscopy may be too high
- Infliximab (IFX)
- Approximately 10mg/kg/dose may be appropriate
- Surgical intervention
- Consult IBD team
- Antibiotics
- Triple/quadruple regimen
- Pain management
- Significant/uncontrolled pain may be a sign of toxic megacolon
- Narcotics contraindicated
- Steroids
- Inpatients on IV methylprednisolone
- Consider oral steroids if PUCAI < 35 at any time during treatment
- Related Video
- How to Treat Dehydration from Stomach Bugs in Children
Initial Assessment:
- History and Physical, Initial Diagnostic Testing
- Consultation with GI Fellow
Does not meet criteria for
Acute Severe Ulcerative Colitis
Acute Severe Ulcerative Colitis
Treat as clinically indicated
Abdominal X-ray
Surgery consultation
Surgery consultation
Meets criteria for Acute Severe/Fulminant
Ulcerative Colitis
Ulcerative Colitis
Inpatient Management of Acute Severe Ulcerative Colitis
(on GI service)
(on GI service)
Clinical guidelines recommend initiation of second-line therapy if there is no response to IV corticosteroids noted within 3-10 days. Guidelines recommend using the third and fifth IV steroid day to determine need for therapy escalation.
Treatment Day 1
Medications |
|
Nutrition |
|
Laboratory Testing | |
Severity Assessment | |
Discuss treatment options with family |
Treatment Day 3
Recheck labs if not done in last 48 hrs: CBC, CRP, consider CMP
PUCAI < 35 |
|
PUCAI 35-45 |
|
PUCAI > 45 |
|
Treatment Day 5
PUCAI < 35 |
|
PUCAI 35-65 |
|
PUCAI > 65 |
|
Post-IFX Treatment
PUCAI < 35 |
|
PUCAI 35-65 |
|
PUCAI > 65 or 35-65 for > 2-5 days |
|
Posted: February 2017
Revised: July 2020
Authors: E. Maxwell, MD; S. Fusillo, MD; A. Grossman, MD; J. Crawford, CNS; K. Wilson, RN; M. Downing
Revised: July 2020
Authors: E. Maxwell, MD; S. Fusillo, MD; A. Grossman, MD; J. Crawford, CNS; K. Wilson, RN; M. Downing
Evidence
- Combination of oral antibiotics may be effective in severe pediatric ulcerative colitis: A preliminary report
- Efficacy of Combination Antibiotic Therapy for Refractory Pediatric Inflammatory Bowel Disease
- Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicenter study.
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