Pseudomembranous Colitis
Antibiotic exposure leads to overgrowth of Clostridium difficile (C. diff) in the bowel which leads to increased toxin production and causes mucosal damage, inflammation and necrosis.
History
Profuse watery or mucoid diarrhea +/- bloody, tenesmus, fever, abdominal cramps, tenderness, usually within 1 week of antibiotic therapy.
Examination
Signs of perforation, peritonitis, sepsis and shock or toxic megacolon.
Investigations
FBC - Increased WBC
LFT – decreased albumin
EUC/CMP – electrolyte disturbance and renal dysfunction
Lactate
Stool cultures - unformed stool only
AXR – thumbprinting, toxic megacolon
Consider:
CT abdo- diffuse thickening colon wall
Colonoscopy
Markers of severity
WBC >15
Increased lactate
50% increase in baseline Creatinine
Albumin
Megacolon
Management
Resuscitation with IV fluids +/- inotropes
Correct electrolyte disturbances
Early surgical referral – may require colectomy
Stop offending drugs
Isolate patient
Antibiotics
Mild-moderate: oral metronidazole 400mg (10mg/kg) 8 hourly for 10 days (can be given IV)
Severe: oral vancomycin 125mg (3mg/kg) 6 hourly for 10 days (IV not effective)
Disposition will depend on the patient co-morbidities and severity of diarrhoea and infection
Hand hygeine (i.e. washing with soap and water) is very important as it kills the spores.
Further References and Resources
Trubiano, J. A. et al. (2016) 'Australasian Society for Infectious Diseases guidelines for the diagnosis and treatment of Clostridium difficile infection', Journal of Internal Medicine, vol. 46, no. 4, pp. 479-493.
eTG - Clostridium Difficile