Table 2.
Suggested Management of Active Infections by IBD Medication Class
| Therapeutic Target | Viral, (eg, EBV, VZV, HSV) | Bacterial, (eg, Strep, Staph) |
Opportunistic, (eg, Fungal, Mycobacteria) |
C. difficile |
|---|---|---|---|---|
| TNF | Continue (hold if severe) |
Continue (hold if severe) |
Stop-Treat Severe: Do not restart Mild-Moderate: Consider restart vs. change medicationa |
Continue |
| Integrin | Continue | Continue | Continue | Consider holding dose Treat |
| IL12/23 | Continue (hold if severe) |
Continue (hold if severe) |
Stop-Treat Restart |
Continue |
| JAK | Stop-Treat Severe: Do not restart Mild-Moderate: Consider restart vs. change medicationa |
Continue (hold if severe) |
Stop-Treat Consider restart vs. change medicationa |
Continue |
IL: interleukin; JAK: Janus kinase
Severe infections include those requiring intensive care, those with multiple organs affected, or those meeting systemic inflammatory response criteria.
aDepends on the type and severity of infection and patient’s medication history and remaining medical options. Authors recommend restarting only if no other mechanism of action options exist and infection resolves rapidly with treatment.