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10. The Management Of Pseudomembranous Colitis
10. The Management Of Pseudomembranous Colitis
10. The Management Of Pseudomembranous Colitis
10. The Management Of Pseudomembranous Colitis
10. The Management Of Pseudomembranous Colitis
10. The Management Of Pseudomembranous Colitis
10. The Management Of Pseudomembranous Colitis
10. The Management Of Pseudomembranous Colitis
10. The Management Of Pseudomembranous Colitis
10. The Management Of Pseudomembranous Colitis
10. The Management Of Pseudomembranous Colitis
10. The Management Of Pseudomembranous Colitis
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10. The Management Of Pseudomembranous Colitis

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  • 1. Pseudomembranous colitis is a disease commonly associated with hospitalisation or prior antibiotic exposure Results from an inflammatory reaction of the bowel wall to the luminal toxin produced by Clostridium difficile
  • 2. Discontinuation of antibiotics or other potentially inciting agents Supportive care for diarrhea i.e fluid repletion and electrolyte balance 25% of cases resolve without further treatment Isolation precautions i.e proper handwashing and disinfections
  • 3. Specific for Clostridium difficile First line therapy – Oral metronidazole, oral vancomycin Second line therapy – Oral bacitracin, Teicoplanin, Fusidic acid, Anion exchange resin agents Surgical intervention
  • 4. Effective (response rate 86-90%) and inexpensive Antibiotic against various anaerobes and protozoa Oral dose 250mg qid for 7-10 days Relapse rate 8-9% of cases Contraindication: Children below 10yrs and women during pregnancy
  • 5. Most reliable treatment (response rate 90-100%) Poorly absorbed (less side effects) There is risk of developing vancomycin-resistant enterococci Oral dose 125mg qid for 7-10 days In the setting of ileus, higher dose 500mg qid for 7-10 days to deliver adequate doses
  • 6. Indications : Patients cannot tolerate or fail to respond to metronidazole Organisms resistant to metronidazole Patients less than 10yrs old or pregnant Patients who are critically ill due to C.difficile infection e.g toxic megacolon or colonic perforation
  • 7. Not commonly associated with resistance to metronidazole Mostly occur 3-10 days after discontinuation of treatment Should be treated with second course of metronidazole Some authors report success in preventing relapses with tapering regimen of vancomycin given daily or every other day for 1-2 months For patients who do not respond to either regimen of metronidazole or vancomycin – combination of vancomycin and rifampicin – sometimes beneficial
  • 8. Bacitracin and teicoplanin (antibiotics) Anion-exchange binding resin (Cholestyramine) – binds cytotoxin of C.difficile – do not use together with vancomycin Repopulation of gut flora – ingestion of yeast Saccharomyces boulardii (in relapses) NB: Antidiarrheal agent SHOULD BE AVOIDED because it will prolong mucosal exposure to toxin and this also applies to post-op narcotic anaelgesia
  • 9. Indicated for patients who are complicated with toxic megacolon with existing or subsequent risk of perforation Frequency is low (0.39 – 3.6%) Diverting ileostomy or subtotal colectomy Colostomy/ileostomy- for direct instillation of antibiotics into the colon lumen in patients with ileus (rare) Early subtotal colectomy- in fulminant toxic cases that do not respond to treatment after 7 days due to increased risk of perforation Overall mortality rate for patients requiring surgery is 30-35%
  • 10. Not required however return of diarrhea may indicate the need for retreatment 10-20% of patients will have a relapse If properly treated, it is a self-limiting disease with good prognosis Overall mortality rate is 2% Mortality rate in untreated elderly or debilitated patients = 10-20% Mortality rate in patients with toxic megacolon = 35%
  • 11. 1. Pseudomembranous colitis: Surgical Perspective http://www.emedicine.com/med/topic 2743.htm 2. Harrison’s Principles of Internal Medicine 14th Edition. McGraw-Hill Companies Inc.1998 3 Rang HP, Dale MM, Ritter JM. Pharmacology 3rd Edition. Churchill Livingstone.1995

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