Up to 40% of patients receiving antibiotics have a diarrhoeal illness and a quarter of these may be due to enterotoxigenic strains of Clostridium difficile. It is the production of toxin A and B that is responsible for the diarrhoeal illness. Generally the organism is nosocomially acquired and usually comes to light after antibiotic therapy particularly broad spectrum agents such as Augmentin, amoxicillin, macrolides, ciprofloxacin and cephalosporins. The culture of non-toxigenic Clostridium difficile does not itself require any treatment and in this patients case, he may have acquired an antibiotic related diarrhoea. Therefore, stopping the antibiotic may be all that is required. In asymptomatic patients or patients with mild disease and toxigenic Clostridium difficile, again no treatment is required. However, the patient with profuse watery diarrhoea merits treatment with metronidazole as the first line agent. Vancomycin should be reserved for severe, life-threatening cases of C. difficile infection, for patients unable to tolerate metronidazole, or for patients without symptom resolution after completing a course of metronidazole. Vancomycin is more expensive than metronidazole and the emergence of vancomycin-resistant enterococci is also a concern. Alternative therapies for cases of mild C. difficile infection include bacitracin, teicoplanin, or a binding resin such as cholestyramine or colestipol. However, these agents are not as reliable or as effective as vancomycin or metronidazole.
Posted on: Sat, 05 Jul 2014 13:45:00 +0000
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