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Pseudomembranous colitis


Alternative names

Antibiotic associated colitis; Colitis - pseudomembranous; Necrotizing colitis

Definition

Pseudomembranous colitis is a complication of antibiotic therapy that causes severe inflammation (irritation and swelling with presence of excess immune cells) in areas of the colon.

Causes, incidence, and risk factors

Almost any antibiotic can cause this condition. Clostridium difficile , which occurs normally in the intestine, overgrows when antibiotics are taken. This bacteria releases a powerful toxin which then causes the symptoms. The lining ( mucosa ) of the colon becomes raw and bleeds ( hemorrhagic ). Risk factors are antibiotic usage, chemotherapy for cancer, advanced age, recent surgery, and history of previous pseudomembranous colitis.

Ampicillin is the most common antibiotic associated with this disease in children. Pseudomembranous colitis is rare in infants less than 12 months old because of the presence of protective maternal antibodies .

Symptoms

  • Watery diarrhea
  • Urge to defecate
  • Abdominal cramps
  • Low-grade fever
Additional symptoms that may be associated with this disease:
  • Stools, bloody
  • Abdominal pain

Signs and tests

Either or both of the following tests will confirm the disorder:
  • A stool culture positive for C. difficile toxin
  • A colonoscopy showing pseudomembranous colitis (a characteristic appearance of the colon)

Treatment

The antibiotic causing the condition should be stopped. Metronidazole is usually used to treat the disorder, but oral vancomycin can also be used. Rehydration with oral electrolyte solutions or intravenous therapy may be indicated to replace fluids lost by diarrhea . In rare cases surgery is required to treat infections that worsen or do not respond to antibiotics.

Expectations (prognosis)

The outcome is generally good without complications.

Complications

  • Perforation (hole) of the colon
  • Dehydration with electrolyte imbalance
  • Toxic megacolon

Calling your health care provider

Call your health care provider if persistent diarrhea develops or blood in the stool is noted after taking antibiotics.

Call your health care provider if severe abdominal pain , dehydration ( dry skin , dry mouth, glassy appearance of the eyes, sunken fontanelles in infants, rapid pulse , confusion , excessive tiredness ), or other new symptoms develop.

Prevention

People who have had an episode of pseudomembranous colitis should discuss the risks versus benefits with their physicians before taking antibiotics again.

Update Date: 5/5/2002

Andrew J. Muir, M.D. M.H.S., Division of Gastroenterology, Duke University Medical Center, Durham, NC. Review provided by VeriMed Healthcare Network.

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Last updated: Tue, 06 Jan 2009 00:20:03 GMT
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