Clostridium Difficile Colitis (cont.)
How is C. difficile colitis treated?
Treatment of C. difficile colitis includes:
- correction of dehydration and
electrolyte (mineral) deficiencies,
- discontinuing the antibiotic that caused the
colitis, and
- using antibiotics to eradicate the C. difficile bacterium.
In
patients with mild colitis, stopping the antibiotic that caused the infection
may be enough to cause the colitis and diarrhea to subside. In most cases,
however, antibiotics are needed to eradicate the C. difficile bacteria.
Antibiotics that are effective against C. difficile include
metronidazole
(Flagyl), and vancomycin (Vancocin). These two antibiotics usually are taken
orally for 10 days. Both antibiotics are equally effective. With either
antibiotic, fever usually will resolve in one or two days, and diarrhea in three
or four days.
The choice of which antibiotic to use depends on the individual patient's
situation and the preferences of the treating doctor. Some doctors will
prescribe metronidazole first because it is much cheaper than vancomycin.
Vancomycin is reserved for patients who do not respond to metronidazole, are
allergic to metronidazole, or develop side effects from metronidazole. Other
doctors will prescribe vancomycin first for severe colitis because vancomycin
can achieve much higher antibiotic levels in the colon than metronidazole (and
higher antibiotic levels theoretically would be more effective in killing
bacteria).
Why are there relapses of C. difficile colitis?
Approximately 20% of successfully treated patients can experience a relapse of
C. difficile colitis with recurrence of diarrhea, abdominal cramps, and
abdominal pain. Relapses typically occur 3-10 days after vancomycin or
metronidazole is stopped. Some patients experience a second or even a third
relapse after additional courses of antibiotics.
The most likely explanation for relapse is that the C.difficile has not been
completely eradicated by the initial course of antibiotics. C. difficile in its
active bacterial form is killed by either metronidazole or vancomycin, but the
spores are resistant to killing. Several days after stopping antibiotics, the
surviving spores transform into active bacterial forms which will multiply and
produce toxins again.
Another reason
for relapse is the body's inadequate production of antibodies against the
bacterial toxins. Antibodies are proteins that the body produces to fight
bacterial, viral, and parasitic infections, as well as to protect the body from
the harmful effects of toxins. Therefore, adults who are capable of producing
adequate antibodies against
C. difficile toxins usually do not develop
C.
difficile colitis. Some adults who cannot produce these antibodies are
susceptible to relapses.
Next: How are relapses of Clostridium difficile colitis treated? »
- metronidazole, Flagyl - Explains the medication metronidazole (Flagyl) an antibiotic drug used against anaerobic bacterteria and certain parasites like giardia and ameba that can infect parts of the human body. Article includes descriptions, uses, drug interactions, and side effects.
- Electrolytes - Read about blood electrolytes (sodium, potassium, chloride, and bicorbonate) and the effects of electrolyte imbalances like kidney failure, low blood pressure, hypokalemia, and hyperkalemia.
- Abdominal Pain - Learn about abdominal pain (pain in the stomach / abdomen) including causes, symptoms, how abdominal pain is diagnosed, and how abdominal pain is treated.
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