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Acute right-sided hemorrhagic colitis associated with oral administration of ampicillin
Abstract:
Among 56 cases who presented to Kanto-Teishin Hospital complaining of bloody diarrhea or considerable hematochezia of acute onset, 8 cases (14.3%) were considered due to colitis associated with oral ampicillin therapy. The bloody diarrhea, often with abdominal cramps, began 2-7 days after starting the treatment. The dosage of ampicillin taken ranged from 2.0 to 4.5 g. Early total colonoscopy and biopsy revealed marked mucosal hemorrhage with minimal or no inflammatory changes mainly in the right colon. Rectum and sigmoid colon are completely normal except in one case. Symptoms rapidly resolved after the endoscopy. At follow-up colonoscopy, performed 4-12 days later, the mucosal changes had cleared completely. There was no evidence to support a hypersensitivity reaction of the colonic mucosa to ampicillin. We believe that right-sided hemorrhagic colitis is one of the common forms of colitis associated with ampicillin. Its differentiation from other kinds of acute colitis and the importance of early total colonoscopy are discussed.
Insights
Ampicillin-associated colitis can cause bloody diarrhea and abdominal cramps. Early colonoscopy is crucial for diagnosing this right-sided hemorrhagic colitis, which resolves quickly after ampicillin discontinuation.
Area of Science:
- Gastroenterology
- Internal Medicine
- Pharmacology
Background:
- Antibiotic-associated colitis is a significant clinical concern.
- Oral ampicillin has been implicated in gastrointestinal adverse events.
Purpose of the Study:
- To investigate the incidence and characteristics of colitis associated with oral ampicillin therapy.
- To evaluate the role of early colonoscopy in diagnosing and managing ampicillin-induced colitis.
Main Methods:
- Retrospective analysis of 56 patients presenting with acute bloody diarrhea or hematochezia.
- Endoscopic examination (colonoscopy) and biopsy for diagnosis.
- Clinical follow-up after ampicillin cessation and endoscopy.
Main Results:
- Eight cases (14.3%) of colitis were attributed to oral ampicillin.
- Symptoms included bloody diarrhea and abdominal cramps, starting 2-7 days after ampicillin initiation (2.0-4.5 g/day).
- Colonoscopy revealed right-sided hemorrhagic colitis with minimal inflammation; symptoms resolved rapidly post-endoscopy and ampicillin withdrawal.
Conclusions:
- Right-sided hemorrhagic colitis is a common presentation of ampicillin-associated colitis.
- Early total colonoscopy is vital for differentiating ampicillin-induced colitis from other acute colitides.
- The condition appears to be non-hypersensitivity mediated and resolves promptly with ampicillin discontinuation.