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A.D.A.M. Medical Encyclopedia.
Pseudomembranous colitis is infection of the large intestine (colon) with an overgrowth of Clostridium difficile bacteria.
Causes, incidence, and risk factors
The Clostridium difficile bacteria is normally seen in the intestine. However, it may overgrow when you take antibiotics. The bacteria release a powerful toxin that causes the lining of the colon to become inflammed and bleed.
The most common antibiotics associated with this condition are ampicillin, clindamycin, fluoroquinolones, and cephalosporins.
Pseudomembranous colitis is rare in infants younger than 12 months old and uncommon in children. It is most often seen in people who are in the hospital. However, it is becoming more common in people who take antibiotics and who are not in the hospital.
Risk factors include:
- Older age
- Antibiotic use
- Use of medicines that weaken the immune system, including chemotherapy
- Recent surgery
- Personal history of pseudomembranous colitis
Symptoms
- Abdominal cramps (mild to severe)
- Fever
- Urge to have a bowel movement
- Watery diarrhea (often five to 10 times per day)
Signs and tests
Either or both of the following tests will confirm the disorder:
- Colonoscopy or flexible sigmoidoscopy
- Immunoassay for C. difficile toxin in the stool
Treatment
The antibiotic or other medicine causing the condition should be stopped. Metronidazole is usually used to treat the disorder, but other medicines may also be used.
Electrolyte solutions or fluids given through a vein may be needed to treat dehydration due to diarrhea. In rare cases, surgery is needed to treat infections that get worse or do not respond to antibiotics.
Expectations (prognosis)
If there are no complications, the outlook is generally good. However, up to 20% of infections may return, requiring additional treatment.
Complications
- Dehydration with electrolyte imbalance
- Perforation of (hole through) the colon
Calling your health care provider
Call your health care provider if the following symptoms occur:
- Bloody stools after taking antibiotics
- Five or more episodes of diarrhea per day for more than 1-2 days
- Severe abdominal pain
- Signs of dehydration (dry skin, dry mouth, glassy appearance of the eyes, sunken soft spots on top of head in infants, rapid pulse, confusion, excessive tiredness)
Prevention
People who have had pseudomembranous colitis should inform their doctors before taking antibiotics again.
References
- Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31(5):431-455. [PubMed: 20307191]
- Gerding DN, Johnson S. Clostridial infections. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 304.
- Thielman NM, Wilson KH. Antibiotic-associated colitis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 96.
Review Date: 4/17/2012.
Reviewed by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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Antibiotic therapy for Clostridium difficile‐associated diarrhea in adults
Diarrhea may be a side effect of many commonly used antibiotics, and in some cases may be due to overgrowth of a bacterium called Clostridium difficile (C. difficile) in the colon after other bacteria have been killed. The seriousness of C. difficile‐associated diarrhea (CDAD) can range from being a nuisance, to a life threatening or even fatal disease. The treatment of CDAD is usually cessation of the initiating antibiotic and immediate administration of a different antibiotic. However each of these steps, cessation of the original antibiotic, immediate retreatment, and the choice of a new antibiotic are poorly supported by currently available evidence. Fifteen studies (total 1152 participants) of antibiotic treatment of CDAD were included in this review. Nine different antibiotics were investigated: vancomycin, metronidazole, fusidic acid, nitazoxanide, teicoplanin, rifampin, rifaximin, bacitracin and fidaxomicin (OPT‐80). Most of the studies were compared vancomycin with other antibiotics. Vancomycin was found to be superior to placebo (fake medicine) for improvement of the symptoms of CDAD including resolution of diarrhea. Most of the studies found no statistically significant difference in effectiveness between vancomycin and other antibiotics including metronidazole, fusidic acid, nitazoxanide or rifaximin. Teicoplanin was found to be superior to vancomycin for curing the C. difficile infection. Teicoplanin may be an attractive choice for the treatment of CDAD. However, it is expensive compared to the other antibiotics and is of limited availability. Side effects including surgery and death occurred infrequently in the included studies. There was a total of 18 deaths among 1152 patients in this systematic review. These deaths were attributed to underlying disease rather than CDAD or antibiotic treatment. One study reported a partial colectomy (removal of the diseased part of the colon) after failed CDAD treatment. It is questionable whether mild CDAD needs to be treated. The included studies provide little evidence for antibiotic treatment of severe CDAD as many studies attempted to exclude these patients. Considering the goals of CDAD therapy: improvement of the patient's clinical condition and prevention of spread of C. difficile infection to other patients, one should choose the antibiotic that brings both symptomatic cure and bacteriologic cure. A recommendation to achieve these goals cannot be made because of the small numbers of patients in the included studies and the poor methodological quality of these studies. Over time there have been emerging therapies for the treatment of clostridium difficile such as resins, new biological compounds and probiotics as alternatives to antibiotics. These interventions along with antibiotic therapy for Clostridium difficile‐associated diarrhea need further investigation.
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