This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Robert Fekety, MD; Akshay B. Shah, MD

JAMA. 1993;269(1):71-75.

Abstract
Pseudomembranous colitis associated with antibiotic therapy is almost always due to an overgrowth of Clostridium difficile. If untreated, pseudomembranous colitis can lead to severe diarrhea, hypovolemic shock, toxic dilatation of the colon, cecal perforation, hemorrhage, and death. However, C difficile— associated colitis can mimic the more common "benign" antibiotic-associated diarrhea that is not caused by C difficile. An algorithm for diagnosis management of hospitalized patients with antibiotic diarrhea and C difficile colitis is presented in this review. Diagnosis depends on sigmoidoscopy and/or stool tests for C difficile toxins in all patients with antibiotic-associated diarrhea. If the results of these tests are positive, either metronidazole or vancomycin is recommended for treatment of mild illness, and vancomycin is recommended for treatment of severe illness. Oral therapy is always preferred because it is more reliable. In patients with recurrent or relapsing colitis, treatment with either metronidazole or vancomycin is effective for that episode, but novel approaches, such as the oral or rectal introduction of competing nonpathogenic organisms, may prove to be more successful in prevention of relapses.

(JAMA. 1993;269:71-75)

Author Affiliations
From the Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (Dr Fekety); and the Division of Infectious Diseases, Loyola University/Hines Veterans Affairs Hospital, Maywood, Ill (Dr Shah). The authors received an honorarium from NCM Publishers, New York, NY, under an educational grant from the Eli Lilly Co, Indianapolis, Ind.

Footnotes
Reprint requests to 3116 Taubman Center, University of Michigan Hospital, Ann Arbor, Ml 48109-0378 (Dr Fekety).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Clinical Outcomes, Safety, and Pharmacokinetics of OPT-80 in a Phase 2 Trial with Patients with Clostridium difficile Infection
Louie et al.
Antimicrob. Agents Chemother. 2009;53:223-228.
ABSTRACT | FULL TEXT  

Tolevamer, an Anionic Polymer, Neutralizes Toxins Produced by the BI/027 Strains of Clostridium difficile
Hinkson et al.
Antimicrob. Agents Chemother. 2008;52:2190-2195.
ABSTRACT | FULL TEXT  

Safety, Tolerance, and Pharmacokinetic Studies of OPT-80 in Healthy Volunteers following Single and Multiple Oral Doses
Shue et al.
Antimicrob. Agents Chemother. 2008;52:1391-1395.
ABSTRACT | FULL TEXT  

Inflammatory Bowel Disease
McLEMORE
radtech 2007;78:291-305.
ABSTRACT | FULL TEXT  

Past, Present, and Future Therapies for Clostridium difficile-Associated Disease
Surowiec et al.
The Annals of Pharmacotherapy 2006;40:2155-2163.
ABSTRACT | FULL TEXT  

Narrative Review: The New Epidemic of Clostridium difficile-Associated Enteric Disease.
Bartlett
ANN INTERN MED 2006;145:758-764.
ABSTRACT | FULL TEXT  

Activity of OPT-80, a Novel Macrocycle, Compared with Those of Eight Other Agents against Selected Anaerobic Species
Credito and Appelbaum
Antimicrob. Agents Chemother. 2004;48:4430-4434.
ABSTRACT | FULL TEXT  

Clostridium difficile colonization in healthy adults: transient colonization and correlation with enterococcal colonization
Ozaki et al.
J Med Microbiol 2004;53:167-172.
ABSTRACT | FULL TEXT  

Clostridium Diffi cile-Associated Diarrhea in a Pediatric Hospital
Spivack et al.
CLIN PEDIATR 2003;42:347-352.
ABSTRACT  

Six Rapid Tests for Direct Detection of Clostridium difficile and Its Toxins in Fecal Samples Compared with the Fibroblast Cytotoxicity Assay
Turgeon et al.
J. Clin. Microbiol. 2003;41:667-670.
ABSTRACT | FULL TEXT  

Antibiotic-Associated Diarrhea
Bartlett
NEJM 2002;346:334-339.
FULL TEXT  

Saccharomyces boulardii Stimulates Intestinal Immunoglobulin A Immune Response to Clostridium difficile Toxin A in Mice
Qamar et al.
Infect. Immun. 2001;69:2762-2765.
ABSTRACT | FULL TEXT  

Clostridium difficile-Associated Diarrhea: A Review
Mylonakis et al.
Arch Intern Med 2001;161:525-533.
ABSTRACT | FULL TEXT  

Pharmacokinetics and comparative effects of telithromycin (HMR 3647) and clarithromycin on the oropharyngeal and intestinal microflora
Edlund et al.
J Antimicrob Chemother 2000;46:741-749.
ABSTRACT | FULL TEXT  

Polymeric IgA Is Superior to Monomeric IgA and IgG Carrying the Same Variable Domain in Preventing Clostridium difficile Toxin A Damaging of T84 Monolayers
Stubbe et al.
J. Immunol. 2000;164:1952-1960.
ABSTRACT | FULL TEXT  

The Role of Probiotic Cultures in the Control of Gastrointestinal Health
Rolfe
J. Nutr. 2000;130:396-396.
ABSTRACT | FULL TEXT  

Activities of Synthetic Hybrid Peptides against Anaerobic Bacteria: Aspects of Methodology and Stability
Oh et al.
Antimicrob. Agents Chemother. 2000;44:68-72.
ABSTRACT | FULL TEXT  

Antibodies to Recombinant Clostridium difficile Toxins A and B Are an Effective Treatment and Prevent Relapse of C. difficile-Associated Disease in a Hamster Model of Infection
Kink and Williams
Infect. Immun. 1998;66:2018-2025.
ABSTRACT | FULL TEXT  

Diarrhea and Clostridium difficile--Associated Diarrhea on a Surgical Service
McCarter et al.
Arch Surg 1996;131:1333-1337.
ABSTRACT  

Biotherapeutic Agents: A Neglected Modality for the Treatment and Prevention of Selected Intestinal and Vaginal Infections
Elmer et al.
JAMA 1996;275:870-876.
ABSTRACT  

A Randomized Placebo-Controlled Trial of Saccharomyces boulardii in Combination With Standard Antibiotics for Clostridium difficile Disease
McFarland et al.
JAMA 1994;271:1913-1918.
ABSTRACT  

Clostridium difficile Colitis: Causes, Cures
Buggy
JAMA 1993;269:2088-2088.
ABSTRACT  

Clostridium difficile Colitis: Causes, Cures
Anand
JAMA 1993;269:2087-2087.
ABSTRACT  

Clostridium difficile Colitis: Causes, Cures
Periman
JAMA 1993;269:2087-2088.
ABSTRACT