Clostridium difficile-associated diarrhea treatment

Wenisch C, Parschalk B, Hasenhundl M, Hirschl AM, Graninger W Comparison of vancomycin, teicoplanin, metronidazole, and fusidic acid for the treatment of Clostridium difficile-associated diarrhea. Clin Infect Dis 1996 22 813-818. 

Diarrhea is a well-known complication of antibiotic therapy. Rates of antibiotic-associated diarrhea (AAD) vary from 5 to 25%. Some antibiotics are more likely to cause diarrhea than others, specifically, those that are broad spectrum and those that target anaerobic flora. This paper reviews the effects of antibiotics on the fecal flora as well as host factors which contribute to AAD. Clinical features and treatment of AAD are also described. Prevention of AAD rests on wise antibiotic policies, the use of probiotics and prevention of acquisition in the hospital setting. Data from clinical trials suggest that poorly absorbed antimicrobials might have a decreased risk of causing AAD and Clostridium difficile-associated disease, as concluded from studies of antibiotics used for preoperative bowel decontamination and poorly absorbed antibiotics used for traveler s diarrhea. Controlled trials would prove this but are not yet available. Probiotics may be a good adjunct to poorly absorbed antibiotics to minimize the risk of diarrhea associated with antibiotics. 

A 66-year-old man is admitted to the intensive care unit of a hospital for treatment of community-acquired pneumonia. He receives ceftriaxone and azithromycin upon admission, rapidly improves, and is transferred to a semiprivate ward room. On day 7 of his hospitalization, he develops copious diarrhea with eight bowel movements that day but is other wise clinically stable. Clostridium difficile-associated colitis is suspected and a toxin assay is sent to confirm this diagnosis. What is an acceptable treatment for the patient s diarrhea The patient is transferred to a single-bed room the following day. The housekeeping staff asks if the old room should be cleaned with alcohol or bleach. Which product should be chosen Why ... 

Gorenek L, Dizer U, Besirbellioglu B, Eyigun CP, Hacibektasoglu A, Van Thiel DH. The diagnosis and treatment of Clostridium difficile in antibiotic-associated diarrhea. Hepatogastroenterology 1999 46(25) 343-8. 

The most notable adverse effect associated with clindamycin is antibiotic-associated colitis secondary to toxigenic Clostridium difficile. This organism usually overgrows in the Gl tract in the presence of antibiotics due to the inhibition of normal Gl flora. Ironically, the drug of choice for the treatment of antibiotic-associated colitis is metronidazole. Clindamycin also can cause diarrhea that is not related to C. difficile. 

Gastrointestinal Acute abdominal pain and bloody diarrhea in an adolescent after treatment with co-amoxiclav for an acute urinary infection were due to Klebsiella oxytoca [45 ]. Antibiotic-associated hemorrhagic colitis due to Klebsiella oxytoca differs from antibiotic-associated diarrhea due to Clostridium difficile in being usually segmental and located predominantly in the right colon. 

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