Learn About Pseudomembranous Colitis
Pseudomembranous colitis refers to swelling or inflammation of the large intestine (colon) due to an overgrowth of Clostridioides difficile (C difficile) bacteria.
This infection is a common cause of diarrhea after antibiotic use. Not all cases of diarrhea associated with antibiotic use are due to C difficile or will progress to pseudomembranous colitis.
Antibiotic-associated colitis; Colitis - pseudomembranous; Necrotizing colitis; C difficile - pseudomembranous; C diff
The C difficile bacteria normally lives in the intestine. However, too much of these bacteria may grow when you take antibiotic medicines. The bacteria give off a strong toxin that causes inflammation and bleeding in the lining of the colon.
Any antibiotic can cause this condition. The medicines responsible for the problem most of the time are ampicillin, clindamycin, fluoroquinolones, and cephalosporins.
Health care providers in the hospital may pass this bacteria from one patient to another.
Pseudomembranous colitis is uncommon in children, and rare in infants. It is most often seen in people who are in the hospital. However, it is becoming more common in people who take antibiotics and are not in a hospital.
Risk factors include:
- Older age
- Antibiotic use
- Use of medicines that weaken the immune system (such as chemotherapy medicines)
- Recent surgery
- History of pseudomembranous colitis
- History of ulcerative colitis, Crohn disease, and inflammatory bowel disease (IBD). C difficile can happen in IBD patients even without taking antibiotics.
Symptoms include:
- Abdominal cramps (mild to severe)
- Bloody stools
- Fever
- Urge to have a bowel movement
- Watery diarrhea (often 5 to 10 times per day)
The antibiotic or other medicine causing the condition should be stopped. Fidaxomicin and vancomycin are most often used to treat the problem. Metronidazole is also effective, but it is no longer a first line choice in the US.
Electrolyte solutions or fluids given through a vein may be needed to treat dehydration due to diarrhea. In rare cases, surgery is needed to treat infections that get worse or do not respond to antibiotics.
Long term antibiotics may be needed if the C difficile infection returns. A treatment called fecal microbiota transplant ("stool transplant") has also been effective for infections that come back.
Your provider may also suggest that you take probiotics if the infection returns.
An antibody treatment may be needed in patients with very high risk of recurrent C difficile to lessen the risk of recurrence.
Mark Wilcox practices in Leeds, United Kingdom. Mr. Wilcox is rated as an Elite expert by MediFind in the treatment of Pseudomembranous Colitis. His top areas of expertise are Pseudomembranous Colitis, Diarrhea, Methicillin-Resistant Staphylococcus Aureus (MRSA), and Viral Gastroenteritis.
Mayo Clinic
Sahil Khanna is a Gastroenterologist in Rochester, Minnesota. Dr. Khanna is rated as an Elite provider by MediFind in the treatment of Pseudomembranous Colitis. His top areas of expertise are Pseudomembranous Colitis, Diarrhea, Viral Gastroenteritis, Colonoscopy, and Endoscopy. Dr. Khanna is currently accepting new patients.
Brigham And Womens Physicians Organization Inc
Colleen Kelly is a Gastroenterologist in Boston, Massachusetts. Dr. Kelly is rated as an Elite provider by MediFind in the treatment of Pseudomembranous Colitis. Her top areas of expertise are Pseudomembranous Colitis, Diarrhea, Crohn's Disease, Colonoscopy, and Endoscopy.
The outlook is good in most cases, if there are no complications. However, up to 1 in 5 infections may return and need more treatment.
Complications may include:
- Dehydration with electrolyte imbalance
- Perforation of (hole through) the colon
- Toxic megacolon
- Death
Contact your provider if you have the following symptoms:
- Any bloody stools (especially after taking antibiotics)
- Five or more episodes of diarrhea per day for more than 1 to 2 days
- Severe abdominal pain
- Signs of dehydration
People who have had pseudomembranous colitis should tell their providers before taking antibiotics again. It is also very important to wash hands well to prevent passing the germ to other people. Alcohol sanitizers do not always work on C difficile.
Summary: Clostridioides difficile infection (CDI) is the most common cause of nosocomial diarrhea, and the most common health care-associated infectious disease in the United States, accounting for 15% of overall infections, nearly 30.000 deaths per year an estimated economic expense of $5 billion/year. In the last decade, most of the burden related to CDI depends on recurrence CDI (rCDI) (3). rCDI is known ...
Summary: Antimicrobial therapy can lead to disruption of the gut microbiome and infection with Clostridioides difficile, a disease associated with high morbidity and mortality, particularly among the elderly. Drawing on observations that pet ownership and close contact with pets are protective against colonization with C. difficile and recurrence of C. difficile infection, the proposed study will test the ...
Published Date: May 14, 2024
Published By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Gerding DN, Young VB. Donskey CJ. Clostridiodes difficile (formerly Clostridium difficle) infection. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 243.
Johnson S, Lavergne V, Skinner AM, et al. Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of clostridioides difficile infection in adults. Clin Infect Dis. 2021; 73(5):e1029-e1044. PMID: 34164674 pubmed.ncbi.nlm.nih.gov/34164674/.
Kelly CP, Khanna S. Antibiotic-associated diarrhea and clostridioides difficile infection. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 112.
Wilcox MH, Dubberke ER. Clostridial and Clostridioides infections. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 271.