Table 2

Appropriateness of treatment options in acute severe colitis in the context of the COVID-19 pandemic: first-line medical therapy

First-line medical therapy
Negative SARS-CoV-2 swab without signs of COVID-19 infectionIP IV corticosteroidsPoorly bioavailable steroids*IFX aloneTacrolimus±corticosteroidsMADoV aloneDiscussion with COVID-19 specialist†
OP IV corticosteroidsIV corticosteroids+IFXCiclosporin±corticosteroidsMADoV as adjunctive therapyThromboprophylaxis
Positive SARS-CoV-2 swab without signs of COVID-19 infectionIP IV steroidsPoorly bioavailable steroids*IFX aloneTacrolimus±corticosteroidsMADoV aloneDiscussion with COVID-19 specialist†
OP IV corticosteroidsIV corticosteroids+IFXCiclosporin±corticosteroidsMADoV as adjunctive therapyThromboprophylaxis
Positive SARS-CoV-2 swab with signs of COVID-19 infectionIP IV corticosteroidsPoorly bioavailable steroids*IFX aloneTacrolimus±corticosteroidsMADoV aloneDiscussion with COVID-19 specialist†
OP IV corticosteroidsIV corticosteroids+IFXCiclosporin±corticosteroidsMADoV as adjunctive therapyThromboprophylaxis
  • Medium grey is considered appropriate, light grey uncertain and dark grey inappropriate

  • *Budesonide MMX/beclometasone.

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

  • IFX, infliximab; IP, inpatient; IV, intravenous; MADoV, metronidazole, amoxicillin, doxycycline, vancomycin or equivalent; methylprednisolone, corticosteroids; MMX, multimatrix; OP, outpatient.