Treatment
Management Of Microscopic Colitis
Clinical Decision Support Tool
Symptomatic microscopic colitis
• Adverse reaction to
budesonide
• Cost of budesonide
• Patient preference
Budesonide 9 mg daily
a
Work-up should include, but not be limited to, evaluation for celiac disease, hyperthyroidism,
irritable bowel syndrome.
b
Maintenance dosing can be tapered to lowest effective dose, which may range from 3 mg every other
day to 6 mg daily.
c
Potential precipitating medications include, but are not limited to: NSAIDs, aspirin, PPI, SSRI,
clozapine and acarbose.
d
ough direct evidence is very limited, case series suggest that azathioprine and anti-TNF agents
may be effective in refractory microscopic colitis.
2nd Line Medical Therapy
• Bismuth subsalicylate
• Prednisone
(prednisolone)
• Mesalamine
Clinical response
NO YES
Treat for 8 weeks
Clinical recurrence
after stopping
budesonide
NO YES
No maintenance
therapy
Budesonide ≤ 6 mg
daily x 6-12 months
b
Work-up for
co-existing causes
for diarrhea
a
Co-existing
condition
NO YES
• Avoid possible
precipitating
medications
c
• Consider alternative
therapies including
immunosuppressants
d
Treat co-existing
conditions
