Pseudomembranous colitis

Pseudomembranous colitis is an infection of the colon with the bacterium Clostridium difficile, which is usually associated with the use of antibiotics.

Clostridium difficile is from the family of bacteria that cause botulism – Clostridium botulinum and tetanus – Clostridium tetani.

The bacterium C. Difficile exists in two forms – one is the inactive or non-infectious form called spores, and the other is the active or infectious form. In spore form, C. Difficile can survive for a long time in the environment, while the active form cannot.

C. difficile colonize the intestinal tract by the oral route, as a result of disruption of the balance of the normal intestinal flora, which is usually due to the use of antibiotics. Although C. Difficile can exist in an active form in the colon of some people, i.e. be a carrier, they can also be ingested in this form – faecal-oral transmission.

Once excreted in the feces, C. Diff can be found in many places, especially in hospitals, nursing homes, and hospices.

The most common location of bacteria is:

• Furniture;
• Sanitary units;
• Stethoscopes;
• Pads;
• Telephones;
• Nails;
• Floors and diapers;
• Jewelry – mostly rings;
• Diaper rooms;
• Other items that are used by patients and doctors;

Over the past 10 years, C. Diff infections have become more frequent, more severe, and resistant to standard therapy.

What are the symptoms?

Diarrhea is the main manifestation of the disease regardless of the severity of the infection, although not everyone is infected. Some people carry the bacteria but do not develop an active infection.

According to studies, about 20% of hospitalized patients are carriers. In nursing homes, this percentage reaches about 50. The infected can expel the infectious organism and cause environmental pollution.

Mild infection can lead to:

• Abdominal pain and cramping;
• Abdominal bloating;
• Nausea or vomiting;
• Fever and fatigue;

With diarrhea, bowel movements can be 10-15 times a day. More severe infections can usually cause severe and profuse diarrhea, abdominal pain and high fever. A manifestation of a severe form of the disease is toxic megacolon, which leads to significant expansion and distension of the large intestine.

Severe cases may be associated with generalized infection /sepsis/, leading to instability of blood pressure and heart rate, as well as disruption of the functions of other body organs /septic shock/. It is not clear why different people react differently to C. Diff infection.

Treatment of Pseudomembranous Colitis

If you suspect a C. Diff infection you should notify your GP immediately. It is important to try to stay hydrated by drinking enough fluids to compensate for water loss due to diarrhea. However, further treatment should be carried out under the supervision of a doctor.

When the diagnosis is confirmed or a C. Diff infection is suspected, prompt treatment should be initiated. In addition to supportive therapy, specific antibiotics should be started. The drug group that is approved for pseudomembranous colitis is metronidazole and vancomycin.

A 10-14 day course of treatment is usually prescribed. Research supports the use of metronidazole, and vancomycin is prescribed in metronidazole intolerance and in the presence of severe recurrent infections.
The typical dose of metronidazole is 500 mg. every 8 hours orally, and for vancomycin it is 125 mg orally every 6 hours.

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