Colitis pseudomembranous

Important members of this toxin family are Clostridium difficile toxins A and B, which are implicated in antibiotics-associated diarrhea and pseudomembranous colitis. The large clostridial cytotoxins are single-chain toxins with molecular masses of 250-308 kDa. The enzyme domain is located at the N terminus. The toxins are taken up from an acidic endosomal compartment. They glucosylate RhoA at Thr37 also, Rac and Cdc42 are substrates. Other members of this toxin family such as Clostridium sordellii lethal toxin possess a different substrate specificity and modify Rac but not Rho. In addition, Ras subfamily proteins (e.g., Ras, Ral, and Rap) are modified. As for C3, they are widely used as tools to study Rho functions [2] [4]. 

Discuss hypersensitivity reactions and pseudomembranous colitis as they relate to antibiotic therapy. 

Pseudomembranous colitis may occur after 4 to 9 days of treatment with penicillin or as long as 6 weeks after the drug is discontinued. 

DIARRHEA Diarrhea may be an indication of a super-infection of the gastrointestinal tract or pseudomembranous colitis. The nurse inspects all stools and notifies the primary health care provider if diarrhea occurs because it may be necessary to stop the drug. If diarrhea does occur and there appears to be blood and mucus in the stool, it is important to save a sample of the stool and test for occult blood using a test such as Hemoccult. If the stool tests positive for blood, the nurse saves the sample for possible further laboratory analysis. 

Therapy with cephalosporins may result in a bacterial or fungal superinfection. Diarrhea may be an indication of pseudomembranous colitis, which is one type of bacterial superinfection. See Chapter 7 for a discussion of bacterial and fungal superinfections and pseudomembranous colitis. 

DIARRHEA. Frequent liquid stools may be an indication of a superinfection or pseudomembranous colitis. If pseudomembranous colitis occurs, it is usually seen 4 to 10 days after treatment is started. 

The nurse inspects each bowel movement and immediately reports to the primary health care provider the occurrence of diarrhea or loose stools containing blood and mucus because it may be necessary to discontinue the drug use and institute treatment for diarrhea, a superinfection, or pseudomembranous colitis. 

Abdominal pain, esophagitis, nausea, vomiting, diarrhea, skin rash, and blood dyscrasias may be seen with the use of the lincosamides. These drag s also can cause pseudomembranous colitis, which may range from mild to very severe Discontinuing the drag may relieve mild symptoms of pseudomembranous colitis. 

Bacterial or fungal superinfections and pseudomembranous colitis (see Chap. 7) may occur with the use of both of these drugs. The administration of any drug may result in a hypersensitivity reaction, which can... 

Vancomycin (Vancocin) acts against susceptible gram-positive bacteria by inhibiting bacterial cell wall synthesis and increasing cell wall permeability. This drug is used in the treatment of serious gram-positive infections that do not respond to treatment with other anti-infectives. It also may be used in treating anti-infective-associated pseudomembranous colitis caused by Clostridium difficile. 

MANAGING DIARRHEA. Diarrhea may be a sign of a superinfection or pseudomembranous colitis, both of which are adverse reactions tiiat may be seen with the administration of any anti-infective. The nurse checks each stool and reports any changes in color or consistency. When vancomycin is given as part of the treatment for pseudomembranous colitis, it is important to record the color and consistency of each stool to determine the effectiveness of therapy. 

These drugs are contraindicated in patients whose diarrhea is associated witii organisms that can harm the intestinal mucosa (Escherichia coli, Salmonella, Shigella) and in patients with pseudomembranous colitis, abdominal pain of unknown origin, and obstructive jaundice The antidiarrheal drugs are contraindicated in children younger than 2 years. 

Clostridium dijficile, described in older texts as of little significance as a pathogen if present in the gut, may, after therapy with antibiotics such as clindamycin or ampicillin, remain uninhibited, grow and produce toxins which give rise to a serious condition known as pseudomembranous colitis. The organism will usually succumb to vancomycin. 

Employed as the hydrochloride and administered by dilute intravenous injection, vancomycin is indicated in potentially life-threatening infections that cannot be treated with other effective, less toxic, antibiotics. Oral vancomycin is the drug of choice in the treatment of antibiotic-induced pseudomembranous colitis associated with the administration of antibiotics such as clindamycin and lincomycin (section 9.3). 

Humans Hydrogen peroxide has been used as an enema or as a cleaning agent for endoscopes and may cause mucosal damage when applied to the surface of the gut wall. Hydrogen peroxide enteritis can mimic an acute ulcerative, ischaemic or pseudomembranous colitis, and ranges from a reversible, clinically inapparent process to an acute, toxic fulminant colitis associated with perforation and death (Bilotta and Waye, 1989). It is conceivable that anecdotal reports of exacerbation of IBD by iron supplementation (Kawai et al. 1992) are mediated by hydroxyl radical production by the Fenton reaction. 

Adverse effects are generally mild and include dryness, erythema, and itching.18 Although rare and seen most often with oral therapy, pseudomembranous colitis can occur with the use of topical clindamycin.19 As with any antibacterial agent, the possibility of resistance exists with the use of topical erythromycin. However, co-administration of erythromycin and benzoyl peroxide has been shown to decrease the incidence of resistance, as well as to improve symptoms of mild to moderate inflammatory acne.20... 

Although their effectiveness is similar to the tetracyclines, the use of erythromycin and clindamycin is often limited due to their potential adverse outcomes. Erythromycin has treatment failure due to resistance and a high incidence of gastrointestinal intolerance, while clindamycin causes diarrhea and carries a risk of developing pseudomembranous colitis with long-term use.3,8... 

Clindamycin Capsules 75, 1 50, 300 mg 1 50-300 mg daily Maintenance dose 1 50 mg daily Diarrhea, pseudomembranous colitis... 

Pseudomembranous colitis Same symptoms as colitis, but sigmoidoscopic examination reveals a characteristic membrane with adherent yellow or off-white plaques, usually in distal colon. 

Monitor the patient for the development of potential complications of treatment such as delayed hypersensitivity reactions, antibiotic-induced diarrhea, pseudomembraneous colitis, or fungal superinfections (manifested as oral thrush). 

Progress in defining new treatments for C. difficile infection has been hindered by the heterogeneous nature of hospital-acquired diarrhea, and in particular by whether colitis and/or pseudomembranous colitis is present in individual cases. Study groups have usually been poorly defined in this context, and given the spontaneous resolution of symptoms in a proportion of cases the true efficacy of treatment approaches often remains uncertain. Enthusiasm to explore new treatment possibilities for C. difficile has been largely fuelled by the apparently high relapse rate of conventional (metronidazole or vancomycin) treatment [138],... 

A randomized open trial, performed in patients with C. difficile pseudomembranous colitis, compared rifaximin (200 mg 3 times daily) to vancomycin (500 mg 2 times daily) and found the two drugs similarly effective [141]. The clearance of bacterial toxins was, however, more rapid with vancomycin. Further large double-blind clinical studies are needed to better define the role of rifaximin in the treatment of C. difficile infection. 

Surawicz CM Antibiotic-associated diarrhea and pseudomembranous colitis Are they less common with poorly absorbed antimicrobials Chemotherapy 2005 51(suppl 1 ) 81—89. 

Surawicz CM, McFarland LV Pseudomembranous colitis Causes and cures. Digestion 1999 60 91-100. 

Antibiotic-associated diarrhea Pseudomembranous colitis Clostridium difficile Rifaximin Clostridium difficile-assodated diarrhea... 

Antibiotics alter the normal colonic flora, leading to loss of colonization resistance, which is the ability of the normal flora to protect against overgrowth of pathogens, especially when the anaerobic flora are depleted [15], In CDAD, the altered colonization resistance can allow for the overgrowth of C. difficile in the colon. The bacteria produces two toxins which cause disease (toxin A, an enterotoxin, and toxin B, a cytotoxin). The toxins of C. difficile inactivate Rho proteins, which results in the loss of cytoskeletal integrity in enterocytes. Cellular damage results in fluid loss, exudation and diarrhea. The most severe form of C. difficile diarrhea is pseudomembranous colitis, which can cause severe colitis, toxic colon and rarely colon perforation and death. 

Rarely, other pathogenic bacteria have been reported to cause pseudomembranous colitis. 

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