Home > Diseases and Conditions > Pseudomembranous colitis
  • We are sorry, but NCBI web applications do not support your browser and may not function properly. More information

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.

A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Pseudomembranous colitis

Antibiotic-associated colitis; Colitis - pseudomembranous; Necrotizing colitis

Last reviewed: May 15, 2014.

Pseudomembranous colitis is infection of the large intestine (colon) with an overgrowth of Clostridium difficile bacteria.

Causes

The Clostridium difficile bacteria normally lives in the intestine. However, too much of these bacteria may grow when you take antibiotics. The bacteria give off a strong toxin that causes inflammation and bleeding in the lining of the colon.

Any antibiotic can cause this condition. The drugs responsible for the problem most of the time are ampicillin, clindamycin, fluoroquinolones, and cephalosporins.

Pseudomembranous colitis is uncommon in children, and rare in infants. It is most often seen in people who are in the hospital. However, it is becoming more common in people who take antibiotics and are not in a hospital.

Risk factors include:

  • Older age
  • Antibiotic use
  • Use of medicines that weaken the immune system (such as chemotherapy)
  • Recent surgery
  • History of pseudomembranous colitis
  • History of inflammatory bowel disease (ulcerative colitis and Crohn's disease)

Symptoms

Exams and Tests

The following tests may be done:

Treatment

The antibiotic or other medicine causing the condition should be stopped. Metronidazole or vancomycin is usually used to treat the problem, 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.

Long term antibiotics may be needed if the C. difficile infection returns. A new treatment called fecal microbiota transplant ("stool transplant") has also been effective for infections that come back.

Your doctor may also suggest that you take probiotics if the infection returns.

Outlook (Prognosis)

The outlook is good in most cases if there are no complications. However, up to 1 in 5 infections may return and need more treatment.

Possible Complications

When to Contact a Medical Professional

Call your health care provider if you have the following symptoms:

  • Any bloody stools (especially after taking antibiotics)
  • Five or more episodes of diarrhea per day for more than 1 - 2 days
  • Severe abdominal pain
  • Signs of dehydration

Prevention

People who have had pseudomembranous colitis should tell their doctors before taking antibiotics again. It is also very important to wash hands well to prevent passing the germ to other people. Alcohol sanitizers do not always work on C. difficile.

References

  1. Eaton SR, Mazuski JE. Overview of severe clostridium difficile infection. Critical Care Clinics. 2013;29(4):827-839. [PubMed: 24094379]
  2. 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]
  3. Gerding DN, Johnson S. Clostridial infections. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 304.
  4. 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: 5/15/2014.

Reviewed by: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Antibiotic therapy for Clostridium difficile‐associated diarrhea in adultsAntibiotic 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. 
See all (2) ...

Figures

  • Digestive system.
    Digestive system organs.

PubMed Health Blog...

read all...

MedlinePlus.gov links to free, reliable, up-to-date health information from the National Institutes of Health (NIH) and other trusted health organizations.

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...