Pseudomembranous colitis management

Pseudomembranous colitis management

Pseudomembranous colitis is caused by Clostridium difficile, a Gram-positive anaerobic bacterium that causes antibiotic-associated diarrhea due to alteration of normal intestinal flora and release of enterotoxins.

Clinical presentation

• Bloody diarrhea

• Abdominal cramps and tenderness

• Nausea

• Fever

• Dehydration

Investigations

• Lower endoscopy showing characteristic pseudomembranous yellowish plaques overlying ulcerated and friable rectosigmoid colonic mucosa

• Laboratory evidence of C. difficile toxin A/B:

  • Stool toxin assay (Toxin B)

  • ELISA assay (Toxin A)

Pharmacological treatment

Discontinue causative antibiotic

Stop the suspected precipitating antibiotic whenever possible.

Antimicrobial therapy

Metronidazole

• Metronidazole (PO) 400 mg 8 hourly for 10–14 days

OR

Vancomycin

• Vancomycin (PO) Adults: 125–500 mg 6 hourly for 10–14 days

Supportive management

• Fluid and electrolyte replacement as indicated

• Monitor hydration status and clinical response