Table 5. Evidence-based treatment of ulcerative colitis (1, 23, 24).
| Medication | Dosage | Mild to moderate ulcerative colitis | Intractable ulcerative colitis | Severe ulcerative colitis | Remission maintenance | ||
| Distal | Extensive | Distal | Extensive | ||||
| Sulfasalazine (oral) | Induction 2–6 g/d Maintenance 2–4 g/d | Yes | Yes | Yes*1 | No*2 | Yes | Yes |
| Mesalazine (suppositories) | Induction 0.5–1.5 g/d Maintenance 0.5–1 g/d | Yes | No | Yes*1 | No*2 | Yes | No |
| Mesalazine (enema) | Induction 1–4 g/d Maintenance 1–4 g/d | Yes | Yes (add-on therapy) | Yes*1 | No*2 | Yes | No |
| Mesalazine (oral) | Induction 1.6–4.8 g/d Maintenance 0.75–4 g/d | Yes | Yes | Yes*1 | No*2 | Yes | Yes |
| Olsalazine | Maintenance 1–2 g/d | No*3 | No*3 | No*3 | No*3 | Yes | Yes |
| Balsalazide | Induction 6.75 g/d (equivalent to Mesalazine 2.4 g/d) Maintenance 4 g/d (equivalent to Mesalazine 1.4 g/d) | Yes | Yes | Yes*1 | No*2 | Yes | Yes |
| Hydrocortisone (enema) | Induction 100 mg/d | Yes | No | Yes*1 | Yes*4 | No | No |
| Budesonide (enema) | Induction 2–8 mg/d | Yes | No | Yes*1 | Yes*4 | No | No |
| Corticosteroids (oral cortisone) | Induction 100 mg/d | Yes | Yes | Yes*1 | No | No | No |
| Corticosteroids (oral prednisolone) | Induction 40–60 mg/d | Yes | Yes | Yes*1 | No | No | No |
| Corticosteroids (prednisolone IV) | Induction 60 mg/d | No | No | Yes*5 | Yes | No | No |
| Azathioprine (oral) | Maintenance 2–2.5 mg/kg/d | No | No | Yes | No | Yes | Yes |
| Ciclosporin (IV) | Induction 2–4 mg/kg/d | No | No | No | Yes | No | No |
| Tacrolimus (oral) | Induction Serum trough level (5–15 ng/mL)*6 | No | No | No | Yes | No | No |
| Infliximab (IV) | Induction 5 or 10 mg/kg in weeks 0, 2, and 6; maintenance 5 or 10 mg/kg every 8 weeks | Yes | Yes | Yes | Yes | Yes | Yes |
For medicolegally binding recommendations regarding indications and dosages, see the Rote Liste ("Red List") and the corresponding information for physicians for the medication in question.
*1, Usually continued in mild and moderate colitis while other agents are gradually introduced in addition.
*2, Usually discontinued because of the possibility of intolerance to sulfasalazine, mesalazine, or balsalazide.
*3, Diarrhea often arises when this agent is given in high doses to patients with ulcerative colitis.
*4, Treatment given in addition to intravenous corticosteroids.
*5, Some patients who do not respond to oral steroids respond to intravenous steroids given as inpatient treatment.
*6, Retrospective and uncontrolled studies show that trough levels of 4–8 ng/dL are also effective and are associated with fewer side effects.