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help the needy essay »» mild to moderate active uc treatment of acute episodes of uc is dictated by the severity and extent of disease viagra chinese name. First-line therapy of mild to moderate disease involves oral or topical aminosalicylate derivatives or oral budesonide. Topical mesalamine is superior to both topical corticosteroids and oral aminosalicylates for inducing remission in active mild to moderate uc. 1,35–37 enemas are appropriate for patients with left-sided disease because the medication will reach the splenic flexure. Suppositories deliver mesalamine up to approximately 20 cm and are most appropriate for treating proctitis. 6,7,35 oral and topical mesalamine preparations may be used together for maximal effect. Oral mesalamine may also be used for patients who are unwilling or unable to use topical preparations. 35–37 topical corticosteroids are usually reserved for patients who do not respond to topical mesalamine. 1,22 patients should be properly educated regarding appropriate use of topical products, including proper administration and adequate retention in order to maximize efficacy. Oral budesonide may be used as either an alternative or add-on to aminosalicylates in patients with active uc. 24 for patients with disease extending proximal to the splenic flexure, oral sulfasalazine or any of the oral mesalamine products are considered first-line therapy. 1,6 doses should provide 4 to 6 g of sulfasalazine or 2. 4 g of mesalamine or equivalent. 6 use of the once-daily formulations may improve patient adherence. 17 induction of remission may require 4 to 8 weeks of therapy at appropriate treatment doses. »» moderate to severe active uc in moderate to severe uc oral corticosteroids may be used for short-term treatment of patients who are unresponsive to sulfasalazine or mesalamine. Prednisone doses of 40 to 60 mg/day (or equivalent) are recommended. 1,22 infliximab, adalimumab, and golimumab are effective for patients with moderate to severe disease who are unresponsive to oral therapies. Azathioprine or 6-mp is used for patients unresponsive to corticosteroids or those who become steroid dependent and may be combined with infliximab for increased effectiveness. 37,38 vedolizumab is generally reserved for patients who fail oral therapies and anti tnf-α agents. 30 »» severe or fulminant uc patients with severe uc symptoms require hospitalization.

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