From the Guidelines
Antibiotics that cause Pseudomembranous colitis include clindamycin, third-generation cephalosporins, fluoroquinolones, and penicillins.
Risk Factors for Pseudomembranous Colitis
- Antibiotic exposure: Nearly all antibiotics have been associated with CDI, but certain classes have been found to be high risk, including:
- Clindamycin
- Third-generation cephalosporins
- Fluoroquinolones
- Penicillins
- Disruption of normal gut flora: Antibiotics suppress the normal bowel microbiota, providing a niche for C. difficile to flourish 1
- Duration and degree of exposure to antibiotics: Longer exposure to antibiotics and exposure to multiple antibiotics increase the risk for CDI 1
Management of CDI
- Discontinuation of unnecessary antibiotics: Strongly recommended for the management of CDI, as antibiotic use is a major risk factor for CDI and recurrence 1
- Antibiotic therapy: First choice for CDI treatment, with molecule choice based on the severity of the disease 1
- Specific antibiotic therapy: Options include metronidazole, oral or intraluminal vancomycin, and oral fidaxomicin 1
From the Research
Antibiotics Associated with Pseudomembranous Colitis
The following antibiotics have been associated with pseudomembranous colitis:
- Clindamycin 2, 3, 4, 5
- Cephalosporins 2, 6, 4
- Ampicillin or amoxicillin 2, 6, 4
- Macrolides (rarely associated) 6
- Cefaclor, cefuroxime axetil, and cyclins (rarely associated) 6
- Ofloxacin and trimethoprim-sulfamethoxazole (2-3 times more frequently associated) 6
- Cefixime and amoxicillin-clavulanic acid (7 times more frequently associated) 6
- Lincomycin 5
- Metronidazole (when used parenterally) 2
- Vancomycin (when used parenterally) 2
Mechanism of Action
The mechanism of action involves the alteration of enteric flora by antibiotic therapy, enabling Clostridium difficile to proliferate and produce toxins with cytopathic and hypersecretory effects on the mucosa 2.
Clinical Symptoms and Diagnosis
The clinical symptoms include watery diarrhea, abdominal cramping, and frequently fever, leucocytosis, and hypoalbuminaemia 2. The diagnosis can be established by endoscopic procedures, sigmoidoscopy, or colonoscopy, and confirmed by microbiological tests such as cycloserine cefoxitin fructose agar (CCFA) stool cultures and stool toxin assays 2, 3, 5.