Hydrocortisone
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Lack of efficacy: case report A 19-year-old man exhibited lack of efficacy during treatment with hydrocortisone for ulcerative colitis (UC). The man presented to a hospital with acute severe colitis (ASC). Six months prior to the presentation, he had been diagnosed with UC and had required unspecified steroid therapy since diagnosis. He had been receiving azathioprine and sulfasalazine [sulphasalazine]. At his last presentation 10 weeks prior, he was also started on infliximab as induction therapy with a partial response. On admission, he reported eight bloody bowel motions per day with associated abdominal pain. Three days prior to admission, flexible sigmoidoscopy revealed moderately-severe colitis. He started receiving IV hydrocortisone 100mg four times per day. Despite 3 days treatment with hydrocortisone, his stool frequency and bleeding failed to improve and he became more anaemic. The man met Oxford criteria for ASC and was therefore offered donor faecal microbiota transplantation (FMT) with a dietary prescription as salvage therapy. Dietary therapy was commenced immediately after initial FMT. His azathioprine and infliximab therapy were continued during the 12 months follow-up period; however, sulfasalazine was stopped 2 months after receiving FMT therapy. Twelve months following FMT, he remained in clinical and endoscopic remission. Costello SP, et al. Faecal microbiota transplantation (FMT) with dietary therapy for acute severe ulcerative colitis. BMJ Case Reports 13: No. 8, Aug 2020. Available from: 803514439 URL: http://doi.org/10.1136/bcr-2019-233135
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Reactions 14 Nov 2020 No. 1830
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