Pseudomembranous colitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
The disease is usually treated with metronidazole (400 mg every 8 hours). Oral vancomycin (125 mg every 6 hourly) is an alternative but, due to its cost, is often reserved for those patients who have experienced a relapse after a course of metronidazole (a common outcome). Vancomycin treatment also presents the risk of the development of vancomycin resistant enterococcus, and its use for the treatment of C. Difficile infection is now questioned by some institutions. Occasionally metronidazole has been associated with the development of pseudomembranous colitis. In these cases metronidazole is still an effective treatment, since the cause of the colitis is not the antibiotic, but rather the change in bacterial flora from a previous round of antibiotics.
Adjunctive therapy may include cholestyramine, a bile acid resin that can be used to bind C. difficile toxin.
Saccharomyces boulardii (a yeast) has been shown in one small study of 124 patient to reduce the recurrence rate of pseudomembranous colitis.[1] A number of mechanisms have been proposed to explain this effect.
Fecal bacteriotherapy, a procedure related to probiotic research, has been suggested as an alternative cure for the disease. It involves infusion of bacterial flora acquired from the feces of a healthy donor in an attempt to repair the bacterial imbalance responsible for the recurring nature of the infection.
Anecdotal evidence suggests kefir can help treat pseudomembranous colitis.
If antibiotics do not control the infection the patient may require a colectomy (removal of the colon) for treatment of the colitis.
References
- ↑ McFarland LV, Surawicz CM, Greenberg RN; et al. (1994). "A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease". JAMA. 271 (24): 1913&ndash, 18. PMID 8201735.
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