Related Experiment Videos
Rifampin and pseudomembranous colitis
Abstract:
Isolates of toxigenic Clostridium difficile, the most frequent cause of antibiotic-associated pseudomembranous colitis, are almost always highly susceptible to rifampin. However, resistant isolates exist and have been associated with colitis in both hamsters and humans given rifampin. Rifampin is rarely implicated in the disease in humans; only six cases have been documented, all in elderly patients receiving treatment for tuberculosis. At least three of these patients had liver disease, and all six had also received one or more other antimicrobial agents. The only isolate of C. difficile from these patients that was studied was resistant to rifampin. The colitis was usually mild and responsive to discontinuation of treatment with rifampin or to oral treatment with vancomycin.
Insights
Clostridium difficile can cause colitis, especially in patients on rifampin. While rare, rifampin-resistant C. difficile strains have been linked to mild colitis, often treatable by stopping rifampin or using vancomycin.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Clostridium difficile is a common cause of antibiotic-associated colitis.
- Most C. difficile isolates are susceptible to rifampin.
- Rifampin-resistant C. difficile isolates have been linked to colitis in animal models and humans.
Purpose of the Study:
- To investigate the role of rifampin in C. difficile-associated colitis.
- To analyze documented cases of rifampin-associated colitis in humans.
Main Methods:
- Review of documented human cases of C. difficile colitis associated with rifampin treatment.
- Analysis of patient demographics, co-morbidities, and concomitant antimicrobial use.
- Characterization of C. difficile isolate susceptibility to rifampin.
Main Results:
- Six cases of C. difficile colitis linked to rifampin were documented, primarily in elderly patients treated for tuberculosis.
- These patients often had co-existing liver disease and received multiple antimicrobial agents.
- The C. difficile isolate from one patient was resistant to rifampin.
- Colitis was generally mild and responded to rifampin cessation or vancomycin treatment.
Conclusions:
- Rifampin is rarely implicated in C. difficile colitis, but resistant strains can cause disease.
- Risk factors may include advanced age, liver disease, and concurrent antibiotic use.
- Discontinuation of rifampin or vancomycin therapy are effective treatment options.