Clostridium Difficile Colitis Treatment & Management

  • Author: Faten N Aberra, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: May 18, 2012
 

Medical Care

The decision to treat C difficile infection and the type of therapy depend on the severity of infection.

No treatment is necessary for asymptomatic carriers.

Cessation of the causative antibiotic is essential when possible. Cessation may be the only treatment necessary for those with mild antibiotic-associated diarrhea without fever, abdominal pain, or leukocytosis. This conservative approach allows for reconstitution of the normal colonic microflora and markedly reduces the risk of relapse.

Patients with mild to moderate diarrhea or colitis should receive antibiotic therapy, metronidazole (oral or intravenous) or vancomycin (oral) for 10 days. For severe disease vancomycin is considered superior to metronidazole due to faster symptom resolution and fewer treatment failures. In several clinical trials, 200mg of oral fidaxomicin administered every 12 hours for 10 days has been found to be noninferior to 125mg of oral vancomycin administered every 6 hours for 10 days for the treatment of C difficile.[7] There was no difference in cure rates based on C difficile disease severity. Symptomatic improvement can be expected within 2-3 days. In fulminant cases combined therapy with intravenous metronidazole and oral vancomycin may be considered.

In general, relapse is common and occurs in up to 27% of cases. Relapse typically occurs 3 days to 3 weeks after treatment is discontinued. Possible reasons for relapse include failure to eradicate the organism from the colon and reinfection from the environment.

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Surgical Care

Fulminant colitis and toxic megacolon may require operative intervention.

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Consultations

  • Gastroenterologist - For consideration of colonoscopy in problematic disease
  • Surgeon - For cases of suspected fulminant colitis, toxic megacolon, or peritonitis
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Contributor Information and Disclosures
Author

Faten N Aberra, MD  Assistant Professor, Department of Medicine, Division of Gastroenterology, University of Pennsylvania School of Medicine

Faten N Aberra, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, Crohns and Colitis Foundation of America, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Craig A Gronczewski, MD  Clinical Assistant Professor, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey; Consulting Staff, Princeton Medical Center; Consulting Staff, Robert Wood Johnson University Hospital

Craig A Gronczewski, MD is a member of the following medical societies: Alpha Omega Alpha and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Jonathan P Katz, MD  Assistant Professor of Medicine, Department of Medicine, University of Pennsylvania School of Medicine

Jonathan P Katz, MD is a member of the following medical societies: American Gastroenterological Association and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Waqar A Qureshi, MD  Associate Professor of Medicine, Chief of Endoscopy, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine and Veterans Affairs Medical Center

Waqar A Qureshi, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

BS Anand, MD  Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

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  2. Bauer MP, Notermans DW, van Benthem BH, et al. Clostridium difficile infection in Europe: a hospital-based survey. Lancet. Jan 1 2011;377(9759):63-73. [Medline].

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  7. Cornely OA, Crook DW, Esposito R, Poirier A, Somero MS, Weiss K, et al. Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial. Lancet Infect Dis. Apr 2012;12(4):281-9. [Medline].

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Endoscopic visualization of pseudomembranous colitis, a characteristic manifestation of full-blown Clostridium difficile colitis. Classic pseudomembranes are visible as raised yellow plaques ranging from 2-10 mm in diameter and scattered over the colorectal mucosa. Courtesy of Gregory Ginsberg, MD, University of Pennsylvania.
Colonic pseudomembranes of pseudomembranous colitis. Photographs courtesy of Eric M. Osgard, MD.
Gross pathology specimen from a case of pseudomembranous colitis revealing characteristic yellowish plaques.
Gross pathology specimen from a case of pseudomembranous colitis, again demonstrating characteristic yellowish plaques.
Frontal abdominal radiograph in a patient with proved pseudomembranous colitis. Note the nodular haustral thickening, most pronounced in the transverse colon.
Barium enema demonstrating typical serrated appearance of the barium column (resulting from trapped barium between the edematous mucosal folds and the plaquelike membranes of pseudomembranous colitis).
Axial CT scan of pseudomembranous colitis.
CT scan of pseudomembranous colitis.
Ultrasound image of pseudomembranous colitis.
 
 
 
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