Article: Pseudomembranous colitis

Pseudomembranous colitis is an infection of the colon caused by the bacterium Clostridium difficile. The illness is characterized by offensive-smelling diarrhea, fever, and abdominal pain. It can be severe, causing toxic megacolon, and even fatal.

In most cases the patient, a patient presenting with pseudomembranous colitis has recently been on antibiotics. Antibiotics disturb the normal bowel bacterial flora that generally keep the bacteria Clostridium difficile under control. Clindamycin is the antibiotic classically associated with this disorder, but any antibiotic can cause the condition. Diabetics and the elderly are also at increased risk, although half of cases are not associated with risk factors.

Treatment

The disease is usually treated with metronidazole. Oral vancomycin is an alternative drug. Occasionally metronidazole has been associated with the development of pseudomembranous colitis. In these cases metronidazole is still effective treatment, since the cause of the colitis is not the antibiotic, but rather the change in bacterial flora from a previous round of antibiotics.

Adjunctive therapy can include cholestyramine, a bile acid resin that can be used to bind C. difficile toxin and Saccharomyces boulardii, a yeast that has shown in one study to provide benefit in pseudomembranous colitis [1].

Fecal bacteriotherapy, a procedure related to probiotic research, has been suggested as a potential cure for the disease. It involves infusion of bacterial flora acquired from the feces of a healthy donor in an attempt to restore bacterial imbalance responsible for the recurring nature of the infection.

If antibiotics do not control the infection the patient may require a colectomy (removal of the colon) for treatment of the colitis.