Table 3

Appropriateness of treatment options in acute severe colitis in the context of the COVID-19 pandemic

Day 5 (rescue therapy)PUCAI 35–65PUCAI >65
Negative SARS-CoV-2 swab without signs of COVID-19 infectionIV corticosteroids 2–5 daysExpedite second-line therapyContinue IV corticosteroids aloneIFX aloneCiclosporin aloneMADoV as adjunctive therapyColectomy
IV corticosteroids+IFXCiclosporin+corticosteroidsTacrolimus±corticosteroidsMADoV aloneDiscussion with COVID-19 specialist*
Positive SARS-CoV-2 swab without signs of COVID-19 infectionIV corticosteroids 2–5 daysExpedite second-line therapyContinue IV corticosteroids aloneIFX aloneCiclosporin aloneMADoV as adjunctive therapyColectomy
IV corticosteroids+IFXCiclosporin+corticosteroidsTacrolimus±corticosteroidsMADoV aloneDiscussion with COVID-19 specialist*
Positive SARS-CoV-2 swab with signs of COVID-19 infectionIV corticosteroids 2–5 daysExpedite second-line therapyContinue IV corticosteroids aloneIFX aloneCiclosporin aloneMADoV as adjunctive therapyColectomy
IV corticosteroids+IFXCiclosporin+corticosteroids†Tacrolimus±corticosteroidsMADoV aloneDiscussion with COVID-19 specialist*
  • Management at day 5: (Medium grey is considered appropriate, light grey uncertain and dark grey inappropriate).

  • *Discussion with appropriate COVID-19 specialist as per local availability.

  • †Disagreement index >1.

  • IFX, infliximab; MADoV, metronidazole, amoxicillin, doxycycline, vancomycin or equivalent; methylprednisolone, corticosteroids.