What is the recommended initial treatment for fulminant ulcerative colitis without systemic toxicity?

The recommended initial treatment for fulminant ulcerative colitis without systemic toxicity is intravenous (IV) steroids. This approach is appropriate because fulminant ulcerative colitis is characterized by severe symptoms, and corticosteroids are effective in rapidly controlling inflammation in the gastrointestinal tract. They help reduce the mucosal inflammation and associated symptoms, leading to improvement in the patient's overall condition.

While IV fluids may be necessary for hydration, they do not address the underlying gastrointestinal inflammation. Oral antibiotics are typically not the first line in managing this condition as they do not handle the acute inflammatory process effectively. Surgical intervention is usually considered later in the course of treatment or if there is a development of complications, such as perforation or severe refractory disease. Thus, initiating therapy with IV steroids is aimed at rapid control of the inflammatory process and fostering recovery, making it the most appropriate choice in this scenario.