Treatment
The disease is treated either with oral vancomycin or with intravenous metronidazole. Oral metronidazole at doses of 500 mg three times a day for 10 to 14 days can be used for mild to moderate cases of C.difficile. Choice of drug depends on severity of disease and the ability to tolerate and absorb oral medications. Vancomycin treatment does present the risk of the development of vancomycin-resistant enterococcus, though it is only minimally absorbed into the blood stream from the gastrointestinal tract. Metronidazole has on occasion been associated with the development of pseudomembranous colitis. In these cases, metronidazole is still an effective treatment, since the cause of the colitis is not the antibiotic, but rather the change in bacterial flora from a previous round of antibiotics. Clostridium difficile infections that do not respond to vancomycin or metronidazole are sometimes treated with oral rifaximin. Fidaxomicin is a new alternative that has been approved for treatment in mid-2011. A small number of academic institutions have successfully treated pseudomembranous colitis with fecal transplants, however this therapy is typically reserved for severe recurrent infections and has demonstrated favorable outcomes for cases that are not curable via antimicrobial options.
Cholestyramine and other bile acid sequestrants should not be used as adjunctive therapy because, though they may bind the C. difficile toxin, they can also inhibit the effects of the primary antibiotic.
Several probiotic therapies have been used as adjunct therapies for pseudomembranous colitis. Saccharomyces boulardii (baker's yeast) has been shown in one small study of 124 patients to reduce the recurrence rate of pseudomembranous colitis. A number of mechanisms have been proposed to explain this effect. Fecal bacteriotherapy is a medical treatment, which involves restoration of colon homeostasis by reintroducing normal bacterial flora using faecal material obtained from a healthy donor, has been successfully used to treat acute pseudomembranous colitis.
If antibiotics do not control the infection, the patient may require a colectomy (removal of the colon) for treatment of the colitis.
Read more about this topic: Pseudomembranous Colitis
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