Definition

What is pseudomembranous colitis?

Pseudomembranous colitis, also called antibiotic-associated colitis or C. difficile colitis, is inflammation of the colon associated with an overgrowth of the bacterium Clostridium difficile (C. diff). This infection is a common cause of diarrhea after antibiotic use.

How common is pseudomembranous colitis?

Pseudomembranous colitis is extremely common. It can affect patients at any age. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of pseudomembranous colitis?

The common symptoms of Pseudomembranous Colitis are:

  • Diarrhea that can be watery or even bloody
  • Abdominal cramps, pain or tenderness
  • Fever
  • Pus or mucus in your stool
  • Nausea
  • Dehydration

Symptoms of pseudomembranous colitis can begin as soon as one to two days after you start taking an antibiotic, or as long as several weeks after you finish taking the antibiotic.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you are currently taking or have recently taken antibiotics and you develop diarrhea, contact your doctor, even if the diarrhea is relatively mild. Also, see your doctor any time you have severe diarrhea, with fever, painful abdominal cramps, or blood or pus in your stool.

Causes

What causes pseudomembranous colitis?

Usually, your body keeps the many bacteria in your colon in a naturally healthy balance. However, antibiotics and other medications can upset this balance. Pseudomembranous colitis occurs when certain bacteria — usually C. difficile — rapidly outgrow other bacteria that normally keep them in check. Certain toxins produced by C. difficile, which are usually present in only tiny amounts, rise to levels high enough to damage the colon.

While almost any antibiotic can cause pseudomembranous colitis, some antibiotics are more likely to cause pseudomembranous colitis than others:

  • Fluoroquinolones, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin)
  • Penicillins, such as amoxicillin and ampicillin
  • Clindamycin (Cleocin)
  • Cephalosporins, such as cefixime (Suprax)

Other medications besides antibiotics can sometimes cause pseudomembranous colitis. Chemotherapy drugs that are used to treat cancer may disrupt the normal balance of bacteria in the colon.

Certain diseases that affect the colon, such as ulcerative colitis or Crohn’s disease, may also predispose people to pseudomembranous colitis.

C. difficile spores are resistant to many common disinfectants and can be transmitted from the hands of health care professionals to patients. Increasingly, C. difficile has been reported in people with no known risk factors, including people with no recent health care contact or use of antibiotics. This is called community-acquired C. difficile.

Risk factors

What increases my risk for pseudomembranous colitis?

There are many risk factors for pseudomembranous colitis, such as:

  • Taking antibiotics
  • Staying in the hospital or a nursing home
  • Increasing age, especially over 65 years
  • Having a weakened immune system
  • Having a colon disease, such as inflammatory bowel disease or colorectal cancer
  • Undergoing intestinal surgery
  • Receiving chemotherapy treatment for cancer

Diagnosis & Treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is pseudomembranous colitis diagnosed?

Tests and procedures used to diagnose pseudomembranous colitis and to search for complications include:

  • Stool sample. There are a number of different stool sample tests used to detect C. difficile infection of the colon.
  • Blood tests. These may reveal an abnormally high white blood cell count (leukocytosis), which may indicate pseudomembranous colitis.
  • Colonoscopy or sigmoidoscopy. In both of these tests, your doctor uses a tube with a miniature camera at its tip to examine the inside of your colon for signs of pseudomembranous colitis — raised, yellow plaques (lesions), as well as swelling.
  • Imaging tests. If you have severe symptoms, your doctor may obtain an abdominal X-ray or an abdominal CT scan to look for complications such as toxic megacolon or colon rupture.

How is pseudomembranous colitis treated?

Treatment strategies include:

  • Stopping the antibiotic or other medication that’s thought to be causing your signs and symptoms, if possible. Sometimes, this may be enough to resolve your condition or at least ease signs, such as diarrhea.
  • Starting an antibiotic likely to be effective against C. difficile. If you still experience signs and symptoms, your doctor may use a different antibiotic to treat C. difficile. This allows the normal bacteria to grow back, restoring the healthy balance of bacteria in your colon. You may be given antibiotics by mouth, through a vein or through a tube inserted through the nose into the stomach (nasogastric tube). Depending on your condition, doctors will use most often use metronidazole (Flagyl), vancomycin, fidaxomicin (Dificid) or a combination.
  • Having fecal microbial transplantation (FMT). If your condition is extremely severe, you may be given a transplant of stool (fecal transplant) from a healthy donor to restore the balance of bacteria in your colon. The donor stool may be delivered through a nasogastric tube, inserted into the colon or placed in a capsule you swallow. Often, doctors will use a combination of antibiotic treatment followed by FMT.

Once you begin treatment for pseudomembranous colitis, signs and symptoms may begin to improve within a few days. Researchers are exploring new treatments for pseudomembranous colitis, including alternative antibiotics and a vaccine.

The natural occurrence of new, more-aggressive strains of C. difficile, which are more resistant to antibiotics, has made treating pseudomembranous colitis increasingly difficult and recurrences more common. With each recurrence, your chance of having an additional recurrence increases. Treatment options may include:

  • Repeat antibiotics. You may need a second or third round of antibiotics to resolve your condition.
  • Surgery may be an option in people who have progressive organ failure, rupture of the colon and inflammation of the lining of the abdominal wall (peritonitis). Surgery has typically involved removing all or part of the colon (total or subtotal colectomy). A newer surgery that involves laparoscopically creating a loop of colon and cleaning it (diverting loop ileostomy and colonic lavage) is less invasive and has had positive results.
  • Fecal microbial transplantation (FMT). FMT is used to treat recurrent pseudomembranous colitis. You’ll receive healthy, cleaned stool in a capsule, nasogastrically or inserted into your colon.

Lifestyle changes & Home remedies

What are some lifestyle changes or home remedies that can help me manage pseudomembranous colitis?

The following lifestyles and home remedies might help you cope with pseudomembranous colitis:

  • Drink plenty of fluids. Water is best, but fluids with added sodium and potassium (electrolytes) also may be beneficial. Avoid beverages that are high in sugar or contain alcohol or caffeine, such as coffee, tea and colas, which can aggravate your symptoms.
  • Choose soft, easy-to-digest foods. These include applesauce, bananas and rice. Avoid high-fiber foods, such as beans, nuts and vegetables. If you feel your symptoms are improving, slowly add high-fiber foods back to your diet.
  • Eat several small meals, rather than a few large meals. Space the smaller meals throughout the day.
  • Avoid irritating foods. Stay away from spicy, fatty or fried foods, and any other foods that make your symptoms worse.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: March 14, 2017 | Last Modified: March 14, 2017

Want to live your best life?
Get the Hello Doktor Daily newsletter for health tips, wellness updates and more.