Information From Your Health Care Provider

PSEUDOMEMBRANOUS COLITIS

Basic information

description

Pseudomembranous colitis is a severe illness that involves the bowels. It affects the lining and deeper layers of the intestines. It usually occurs after a person has taken antibiotics. It more often affects the elderly and women more than men.

FREQUENT SIGNS & SYMPTOMS

Symptoms may be mild to severe.
Watery diarrhea (sometimes bloody) with stomach cramps or pain.
Fever.
Drop in blood pressure, sometimes to shock levels, with weak pulse and rapid heartbeat.
Nausea and vomiting.
Disorientation.
Symptoms usually begin 3 to 9 days after starting antibiotic treatment. In some cases, they may appear days to weeks after treatment has stopped.

causes

Most often the bacterial germ, Clostridium difficile. This germ is found in about 5% of healthy persons and normally causes no problems. It lives in a delicate balance in the bowels with other bacteria. When antibiotics are used for treating bacterial infections, they can upset this bacterial balance of the intestinal tract. This allows Clostridium difficile to grow rapidly and produce a toxin that damages the intestinal wall.

risk increases with

Use of antibiotics, especially lincomycin, clindamycin, ampicillin, chloramphenicol, cephalosporins, penicillin, or sulfa drugs. Multiple antibiotics and longer use increase risk.
Adults over age 60.
Recent surgery and/or a stay in a hospital.
Cancer treatment.
Poor general health.

PREVENTIVE MEASURES

No specific preventive measures. Maintaining good health can help prevent the need for treatment with antibiotics.

expected outcomes

Almost all patients recover. Symptoms will usually disappear in 1 to 2 weeks with treatment. Some may have a relapse, which can be treated successfully.

possible complications

Shock and severe dehydration.
Peritonitis caused by perforation of the intestine.
In people who are elderly and have a serious illness, it can sometimes be fatal.

diagnosis & treatment

general measures

Your health care provider will do a physical exam. Medical tests may include blood studies, stool cultures, and x-rays. An colonoscopy with biopsy may be done. This involves using a lighted, tube-like instrument to see inside the intestines. It is also used to remove a small bit of tissue for viewing under a microscope.
Treatment usually involves drug therapy, supportive care, hospital care if needed, and discontinuing or changing the antibiotic causing the problem.
Mild cases can be treated at home.
Hospital care for moderate to severe cases. Fluids given through a vein (IV) may be required to prevent dehydration.
In rare cases, surgery may be needed due to complications of the bowels and to prevent or treat a perforation (a tear in the wall of the intestine).

medications

Vancomycin, metronidazole, or other drugs may be prescribed to treat the Clostridium difficile infection. They may be taken by mouth or given by injection. Sometimes, repeat treatments may be needed.
Don't take drugs for the diarrhea unless prescribed. They can prolong the infection.
Supplements (e.g., probiotics) that help healthy bacteria grow in the intestines may be recommended.

activity

Limit activities until symptoms of the illness get better. Move legs often while in bed to reduce the risk of deep-vein blood clots. Resume normal activities gradually.

diet

Patients in the hospital may need nutrition given through a vein (IV) for a few days. Then a soft diet may be prescribed until intestinal tract is back to normal.
Patients at home need to drink plenty of fluids.

notify our office if

You or a family member has symptoms of pseudomembranous colitis.
Symptoms return after treatment.