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Pseudomembranous colitis following clarithromycin therapy
J P Teare1, J C Booth, J L Brown
1Department of Medicine, St Mary's Hospital Medical School, Imperial College of Science Technology and Medicine, London, UK.
Objective:
To describe the association of clarithromycin, used to treat Helicobacter pylori infection and duodenal ulceration, with pseudomembranous colitis in two patients.
Setting:
St Mary's Hospital, London, UK.
Patients:
Two female patients aged 77 and 78 years, admitted with duodenal ulceration and H. pylori infection.
Intervention:
Clarithromycin (500 mg three times daily) was administered concurrently with omeprazole (40 mg once daily).
Outcome Measures:
After an initial improvement in symptoms both patients experienced persistent Clostridium difficile-associated diarrhoea.
Conclusions:
High-dose clarithromycin should be used with caution for the treatment of H. pylori infection associated with gastroduodenal ulceration. The drug may induce antibiotic-associated colitis which can lead to morbidity and mortality, particularly in the elderly.