Pseudomembranous colitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pseudomembranous colitis is an infection of the colon often, but not always, caused by the bacterium Clostridium difficile. Still, the expression "C. diff colitis" is used almost interchangeably with the more proper term of pseudomembranous colitis. The illness is characterized by offensive-smelling diarrhea, fever, and abdominal pain. It can be severe, causing toxic megacolon, or even fatal.
Pathophysiology
The use of broad-spectrum antibiotics such as clindamycin and cephalosporins causes the normal bacterial flora of the bowel to be altered. In particular, when the antibiotic kills off other, competing bacteria in the intestine, any bacteria remaining will have less competition for space and nutrients there. The net effect is to permit much more extensive growth than normal of certain bacteria. Clostridium difficile is one such type of bacteria. In addition to proliferating in the bowel, the C. diff also elaborates a toxin. It is this toxin that is responsible for the diarrhea which characterizes pseudomembranous colitis.
Causes
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, cephalosporins, rabeprazole
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
In most cases a patient presenting with pseudomembranous colitis has recently been on antibiotics. Antibiotics disturb the normal bowel bacterial flora. Clindamycin is the antibiotic classically associated with this disorder, but any antibiotic can cause the condition. Even though they are not particularly likely to cause pseudomembranous colitis, but, rather, due to their very frequent use, cephalosporin antibiotics (such as cefazolin and cephalexin) account for a large percentage of cases. Diabetics and the elderly are also at increased risk, although half of cases are not associated with risk factors.
Treatment
Surgery
In rare cases, surgery is needed to treat infections that get worse or do not respond to antibiotics.
Prevention
A randomized controlled trial using a probiotic drink containing Lactobacillus casei, L bulgaricus, and Streptococcus thermophilus was reported to have some efficacy. This study was sponsored by the company that produces the drink studied [1]. Although intriguing, several other studies have been unable to demonstrate any benefit of oral supplements of similar bacteria at preventing CDAD.
References
- ↑ Hickson M, D'Souza AL, Muthu N; et al. (2007). "Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial". BMJ. 335 (7610): 80. doi:10.1136/bmj.39231.599815.55. PMID 17604300.