Pseudomembranous Colitis: An Update

Clostridium difficile is the most common nosocomial infection of the gastrointestinal tract. Most cases are associated with antibiotic therapy that alters the fecal flora, allowing overgrowth of C difficile with production of its toxins. Diagnosis is made by detection of the organism or toxin in the...

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Main Authors: Harpreet S Brar, Christina M Surawicz
Format: Article
Language:English
Published: Wiley 2000-01-01
Series:Canadian Journal of Gastroenterology
Online Access:http://dx.doi.org/10.1155/2000/324025
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author Harpreet S Brar
Christina M Surawicz
author_facet Harpreet S Brar
Christina M Surawicz
author_sort Harpreet S Brar
collection DOAJ
description Clostridium difficile is the most common nosocomial infection of the gastrointestinal tract. Most cases are associated with antibiotic therapy that alters the fecal flora, allowing overgrowth of C difficile with production of its toxins. Diagnosis is made by detection of the organism or toxin in the stools. A variety of different tests can be used, but none is perfect. A stool culture can be positive in someone without diarrhea, ie, a carrier. While the cytotoxin is the gold standard, it is expensive, and there is a delay before results are available. Thus, many laboratories use the enzyme-linked immunoassay tests to detect toxin of C difficile because they are a more rapid screen. Depending on the specific test used, they can detect toxin A, toxin B or occasionally both. Sensitivity and specificity rates vary. First line therapy for C difficile disease should be metronidazole 250 mg qid for 10 days. Vancomycin should be reserved for severe cases where metronidazole has failed or where metronidazole cannot be tolerated or is contraindicated. Recurrent C difficile disease is a particularly vexing clinical problem. A variety of biotherapeutic approaches have been used. Retreatment with antibiotics is almost always necessary. In addition, the nonpathogenic yeast Saccharomyces boulardii has been showed to be of benefit as an adjunct in preventing further recurrences.
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spelling doaj-art-5f710cb1c7534738ad45f90308502e592025-02-03T01:06:41ZengWileyCanadian Journal of Gastroenterology0835-79002000-01-01141515610.1155/2000/324025Pseudomembranous Colitis: An UpdateHarpreet S Brar0Christina M Surawicz1Harborview Medical Center, Seattle, Washington, USAHarborview Medical Center, Seattle, Washington, USAClostridium difficile is the most common nosocomial infection of the gastrointestinal tract. Most cases are associated with antibiotic therapy that alters the fecal flora, allowing overgrowth of C difficile with production of its toxins. Diagnosis is made by detection of the organism or toxin in the stools. A variety of different tests can be used, but none is perfect. A stool culture can be positive in someone without diarrhea, ie, a carrier. While the cytotoxin is the gold standard, it is expensive, and there is a delay before results are available. Thus, many laboratories use the enzyme-linked immunoassay tests to detect toxin of C difficile because they are a more rapid screen. Depending on the specific test used, they can detect toxin A, toxin B or occasionally both. Sensitivity and specificity rates vary. First line therapy for C difficile disease should be metronidazole 250 mg qid for 10 days. Vancomycin should be reserved for severe cases where metronidazole has failed or where metronidazole cannot be tolerated or is contraindicated. Recurrent C difficile disease is a particularly vexing clinical problem. A variety of biotherapeutic approaches have been used. Retreatment with antibiotics is almost always necessary. In addition, the nonpathogenic yeast Saccharomyces boulardii has been showed to be of benefit as an adjunct in preventing further recurrences.http://dx.doi.org/10.1155/2000/324025
spellingShingle Harpreet S Brar
Christina M Surawicz
Pseudomembranous Colitis: An Update
Canadian Journal of Gastroenterology
title Pseudomembranous Colitis: An Update
title_full Pseudomembranous Colitis: An Update
title_fullStr Pseudomembranous Colitis: An Update
title_full_unstemmed Pseudomembranous Colitis: An Update
title_short Pseudomembranous Colitis: An Update
title_sort pseudomembranous colitis an update
url http://dx.doi.org/10.1155/2000/324025
work_keys_str_mv AT harpreetsbrar pseudomembranouscolitisanupdate
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