Pseudomembranous colitis vancomycin therapy

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. 

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. 

Pseudomembranous colitis has been reported in an 86-year-old woman with non-ulcer dyspepsia a few days after she had taken triple eradication therapy (omeprazole 20 mg bd, metronidazole 400 mg tds, and clarithromycin 500 mg bd) she recovered after treatment with oral vancomycin (14). 

Vancomycin hydrochloride is always administered intravenously (never intramuscularly), either by slow injection or hy continuous infusion, for the treatment of systemic infections. In shott-term therapy, the toxic side reactions arc usually slight, hut continued u.sc may lead to impaired auditory acuity, renal damage, phlebitis, and rashes. Bccau.se it is nut assorted or signilicantly degraded in the gastrointc.stinal tract, vancomycin may he administered orally fur the treatment of staphylococcal enterocolitis and for pseudomembranous colitis associated with clindamycin therapy. Some conversion to aglucovancomycin likely (Kcurs in the low pH of the stomach. The latter retains about three-fourths of the activity of vancomycin. 

Metronidazole is used increasingly as primary therapy for pseudomembranous colitis due to Clostridium difficile infection. At doses of250-500 mg orally three times daily for 7-14 days, metronidazole is effective and less expensive than oral vancomycin. Metronidazole also is used in patients with Crohn s disease who have perianal fistulas or significant colonic disease fsee Chapter 38). 

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