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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.

European Journal of Gastroenterology & Hepatology
|March 1, 1995
PubMed
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High-dose clarithromycin for Helicobacter pylori infection may cause antibiotic-associated colitis, particularly in elderly patients. This serious side effect, Clostridium difficile-associated diarrhea, necessitates cautious use of this antibiotic treatment.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Pharmacology

Background:

  • Helicobacter pylori infection and duodenal ulceration are common conditions requiring effective treatment.
  • Clarithromycin is a frequently prescribed antibiotic for H. pylori eradication.
  • Antibiotic-associated colitis is a known but serious potential adverse effect of antimicrobial therapy.

Observation:

  • Two elderly female patients (77 and 78 years) with duodenal ulceration and H. pylori infection were treated with high-dose clarithromycin and omeprazole.
  • Both patients initially improved but subsequently developed persistent Clostridium difficile-associated diarrhea.
  • This suggests a link between the clarithromycin regimen and the development of antibiotic-associated colitis.

Findings:

  • High-dose clarithromycin, when used for H. pylori eradication in patients with gastroduodenal ulceration, is associated with an increased risk of pseudomembranous colitis.

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  • Clostridium difficile-associated diarrhea was a persistent complication in the observed cases.
  • The elderly appear to be particularly susceptible to this adverse event.

    • Implications:

    • Clinicians should exercise caution when prescribing high-dose clarithromycin for H. pylori infection, especially in older adults.
    • The potential for antibiotic-associated colitis, leading to significant morbidity and mortality, must be considered.
    • Alternative treatment strategies or careful monitoring may be warranted for high-risk patients.