2-month history of frequent episodes of loose - vanco

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Topical mesalamine

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Explanation:
The correct answer is E. The patient described here has ulcerative colitis confined to the distal colon, also known as ulcerative proctosigmoiditis. Since the disease is limited to the distal colon, topical agents such as mesalamine (or alternatively hydrocortisone) would be effective in reducing inflammation. Mesalamine is an anti-inflammatory drug used principally to control ulcerative colitis. Its active ingredient is also known as 5-aminosalicylic acid, which is available in the forms of rectal suspension, suppositories, delayed release oral tablets, and controlled release oral capsules. The mode of action is unknown, but is thought to involve topical (since mesalamine is poorly absorbed), rather than systemic, modulation of arachidonic acid metabolites, including prostaglandins, leukotrienes, and hydroxyeicosatetraenoic acids. It is usually well tolerated, but it can cause significant allergic reactions related to sulfite sensitivity.
IV hydrocortisone (choice A) is reserved for patients who do not respond to high doses of oral prednisone.
IV infliximab (choice B) is used for patients with severe refractory Crohn disease.
Oral azathioprine (choice C) is used in Crohn disease and ulcerative colitis in patients already refractory or dependent on steroids to control symptoms or maintain remission.
Oral prednisone (choice D) is not warranted in patients who have not been treated previously with safer medications, such as topical mesalamine or hydrocortisone or oral mesalamine or sulfasalazine.