Management of Pseudomembranous colitis (antibiotic-associated
diarrhoea)
This colitis can be caused by the use of any antibiotic, esp. clindamycin,
lincomydn, ampicillin, the cephalosporins (an exception is vancomycin)
and even metronidazole. It is usually due to an overgrowth of Clostridium
diffi cile, which produces a toxin that causes specifi c infl ammatory lesions,
sometimes with a pseudomembrane and is becoming resistant to antibiotics.
It may occur, uncommonly, without antibiotic usage.
Features
• Profuse watery diarrhoea
• Abdominal cramping and tenesmus, maybe fever
• Within 2 d of taking antibiotic (can start up to 4–6 wks after usage)
• Persists 2 wks (up to 6) after ceasing antibiotic
Diagnosed by characteristic lesions on sigmoidoscopy and a tissue culture
assay for C. difficile toxin.
Treatment
• Cease antibiotic
• Choice 1: metronidazole 400 mg (o) tds for 7–10 d or
• Choice 2: vancomycin 125 mg (o) qid for 10 d
diarrhoea)
This colitis can be caused by the use of any antibiotic, esp. clindamycin,
lincomydn, ampicillin, the cephalosporins (an exception is vancomycin)
and even metronidazole. It is usually due to an overgrowth of Clostridium
diffi cile, which produces a toxin that causes specifi c infl ammatory lesions,
sometimes with a pseudomembrane and is becoming resistant to antibiotics.
It may occur, uncommonly, without antibiotic usage.
Features
• Profuse watery diarrhoea
• Abdominal cramping and tenesmus, maybe fever
• Within 2 d of taking antibiotic (can start up to 4–6 wks after usage)
• Persists 2 wks (up to 6) after ceasing antibiotic
Diagnosed by characteristic lesions on sigmoidoscopy and a tissue culture
assay for C. difficile toxin.
Treatment
• Cease antibiotic
• Choice 1: metronidazole 400 mg (o) tds for 7–10 d or
• Choice 2: vancomycin 125 mg (o) qid for 10 d