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[Antibiotic-associated pseudomembranous colitis: retrospective study of 48 cases diagnosed by colonoscopy]
M Andrejak1, B Lafon, G Decocq
1Service de Pharmacologie Clinique, CHU Sud, Amiens, France.
Abstract:
Pseudomembranous colitis (PMC) is a rare but potentially severe complication of antibiotic treatment, which is characterized by the proliferation of the bacterium Clostridium difficile in the colon. In this retrospective study, 48 cases of endoscopically confirmed PMC were included. The following variables were analysed: characteristics of the patients, antibiotics, clinical, biological and endoscopic features of PMC and its treatment. The antibiotic treatment was often ambulatory (83 per cent) for a broncho-pulmonary infection (42 per cent). In 90 per cent of the cases, the treatment included a -lactam, frequently amoxicillin with clavulanic acid, and in 25 per cent of the cases, a fluoroquinolone. The PMC generally occurred after more than 4 days of treatment and was associated with diarrhoea, abdominal pain, fever and rarely vomiting (23 per cent). The complications were hypokalaemia (37 per cent), renal failure (27 per cent) and/or hypoproteinaemia (50 per cent). Pseumembranes were found between the rectum and the left angle of the colon. All patients recovered after one week of oral treatment with metronidazole and/or vancomycin, often in association with Saccharomyces boulardii.
Insights
Pseudomembranous colitis (PMC), a severe complication of antibiotic use, is linked to Clostridium difficile proliferation. This study found amoxicillin/clavulanic acid and fluoroquinolones were common culprits, but metronidazole or vancomycin with Saccharomyces boulardii effectively treated PMC.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pharmacology
Context:
- Antibiotic-associated diarrhea is a common clinical problem.
- Pseudomembranous colitis (PMC) is a severe form of antibiotic-associated diarrhea caused by Clostridium difficile.
- Understanding risk factors and treatment outcomes for PMC is crucial.
Purpose:
- To analyze patient characteristics, antibiotic exposures, clinical presentation, and treatment outcomes in 48 cases of endoscopically confirmed PMC.
- To identify common antibiotics associated with PMC development.
- To evaluate the efficacy of standard treatments for PMC.
Summary:
- This retrospective study reviewed 48 endoscopically confirmed PMC cases.
- Commonly implicated antibiotics included beta-lactams (e.g., amoxicillin/clavulanic acid) and fluoroquinolones, often for respiratory infections.
- Patients presented with diarrhea, abdominal pain, and fever; complications included electrolyte imbalances and renal failure.
- All patients recovered within a week with oral metronidazole and/or vancomycin, frequently combined with Saccharomyces boulardii.
Impact:
- Provides insights into the clinical spectrum and management of pseudomembranous colitis.
- Highlights the role of specific antibiotics in PMC etiology.
- Supports the use of metronidazole, vancomycin, and Saccharomyces boulardii in PMC treatment protocols.