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Pseudomembranous Colitis
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Pseudomembranous colitis involves inflammation of the colon wall after having received antibiotic therapy for another condition. It is sometimes known as antibiotic-associated colitis or Clostridium difficile colitis. It is caused by an overgrowth of the bacterium known as Clostridium difficile but there can be other bacteria involved in the onset of pseudomembranous colitis. The symptoms can be simply a nuisance or can be life-threatening, depending on the overall health of the individual who has the disease.
The signs of pseudomembranous colitis are the following: abdominal cramps and pain, fever, watery or bloody diarrhea, pus in the stool or mucus in the stool, nausea and vomiting or dehydration. It may start one to two days after getting the antibiotic or can take up to several weeks after the antibiotic is stopped.
The cause of pseudomembranous colitis is a lack of healthy or "good" bacteria in the colon so that the "bad" or unhealthy bacteria predominate. In pseudomembranous colitis, it is the unhealthy Clostridium difficile bacterium that takes over the lower colon, causing infection in the colon. The normal bacterial balance in the colon is disrupted by the antibiotics used to treat infection.
Antibiotics are the most common cause of pseudomembranous colitis. While any antibiotic can cause pseudomembranous colitis, the most commonly used antibiotics causing this condition include quinolone antibiotics, clindamycin, penicillins and cephalosporin antibiotics. Pseudomembranous colitis can also be caused by those with cancer on chemotherapy and in those who have inflammatory diseases of the colon, such as Crohn's colitis and ulcerative colitis.
Those things that increase the risk of pseudomembranous colitis include the taking of antibiotics, being older than 65 years of age, staying in the hospital or nursing home, having a poor immune system, having intestinal surgery, having chemotherapy or a colon disease as a preexisting factor.
There can be serious complications of having pseudomembranous colitis, including having a low potassium in the blood called hypokalemia. You can also have low blood pressure from having dehydration, decreasing your kidney function, getting a hole or perforation in the colon or having toxic megacolon, where the colon is distended and can possibly rupture.
Doctors can test for the disease by taking a stool sample and checking for the presence of Clostridium difficile in the stool. Blood tests can show a high white count consistent with a colon infection. Colon testing through a colonoscopy can show the presence of inflammation of the colon directly. There will be raised, yellow plaques of infection found in the colon and the colon can be swollen. A CT scan or x-ray of the abdomen can show toxic megacolon or air fluid levels consistent with a colon that just isn't working well.
The treatment involves stopping the antibiotic if you are still on it. This may take care of the presence of the pseudomembranous colitis altogether. You can change antibiotics to one that is less likely to cause an infection of the colon. You may need either oral or intravenous antibiotics. You may also need a nasogastric tube in order to drain the input to the colon before it gets there. The pressure on the colon is also reduced with a nasogastric tube. Pseudomembranous colitis has a tendency to recur, even when supposedly treated successfully. A second go-round of antibiotics may be necessary or, rarely, surgery is necessary in order to remove the portion of the colon that is severely damaged from colitis.
Probiotic therapy is sometimes used to get rid of the "bad" bacteria and to restore the good bacteria to the system. Probiotics are spores or live cultures of healthy bacteria that are taken by mouth and are colonized in the colon, making sure it takes over and restores the balance of the bacteria of the colon.