View Full Chapter Figures Only Tables Only Videos Only Print Share Email Send Email Your Name (required) ! Example: John Doe Email Address (required) ! Please enter a valid sender email address. Example: firstname.lastname@example.org CC Me Recipient Email Address (required) ! Separate multiple email address with semi-colons (up to 5). Subject Subject for your email. Message (Maximum characters: 1,000) Submit Cancel Thank you! Your email has been sent to: Return to: Send Another Email An error has occurred sending your email(s). Please try again later or contact an administrator at OnlineCustomer_Service@mheducation.com. Return to: Twitter Facebook Linkedin Reddit Get Citation Citation AMA Citation Colitis, Antibiotic-Associated. In: Doherty GM. Doherty G.M. Ed. Gerard M. Doherty.eds. Quick Answers Surgery New York, NY: McGraw-Hill; 2010. http://accesssurgery.mhmedical.com/content.aspx?bookid=853§ionid=49662047. Accessed March 25, 2017. MLA Citation . "Colitis, Antibiotic-Associated." Quick Answers Surgery Doherty GM. Doherty G.M. Ed. Gerard M. Doherty. New York, NY: McGraw-Hill, 2010, http://accesssurgery.mhmedical.com/content.aspx?bookid=853§ionid=49662047. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager © Copyright Tools Search Book Top Return Clip Colitis, Antibiotic-Associated + Essential Features Print Section + • Results from antibiotic therapy or alteration in colonic flora• Diarrhea with or without gross mucosal abnormalities• Caused by Clostridium difficile toxins A and B• Also referred to as pseudomembranous colitis• Clindamycin, ampicillin, cephalosporins are common inciting antibiotics• May progress to toxic megacolon, perforation• Symptoms may develop up to 6 weeks following antibiotic treatment ++ Epidemiology + • Transmitted in hospital or closed environments• Epidemics noted on surgical wards• Can be transmitted by health care personnel, making wearing gloves and washing hands essential• Infection can be especially severe in immunocompromised patients + Clinical Findings Print Section ++ Symptoms and Signs + • Watery, green diarrhea, sometimes bloody• Crampy abdominal pain, cramping• Vomiting• Fever• Complications including toxic megacolon or perforation may lead to peritoneal signs ++ Laboratory Findings + • Leukocytosis• Positive tests for C difficile cytotoxin• Positive stool culture ++ Imaging Findings + • Endoscopy (sigmoidoscopy)-Elevated plaques-Pseudomembranes-Erythematous, edematous mucosa• Biopsy-Leukocytes-Necrotic epithelium-Fibrin + Diagnostic Considerations Print Section + • Malignancy• Stricture• Ischemic colitis• Diverticulitis ++ Rule Out + • Other causes of infectious colitis-Amebic-Actinomycosis-Cytomegalovirus (in immunocompromised patients) + Work-up Print Section + • Sigmoidoscopy/colonoscopy with or without biopsy• Stool culture, C difficile cytotoxin• WBC count• History of antibiotic therapy ++ When to Admit + • Dehydration• Worsening abdominal pain/distention + Treatment and Management Print Section + • Discontinue inciting antibiotic• Oral vancomycin for 7-10 days• Oral metronidazole for 7-14 days• Avoid antidiarrheal medications ++ Surgery ++ Indications + • Failure of medical management with worsening clinical course/progression to toxic megacolon, peritonitis, perforation ++ Medications + • Oral vancomycin• Oral metronidazole ++ Treatment Monitoring + • Serial abdominal exams• Serial WBC count ++ Complications + • Sepsis• Colonic dilatation, perforation• Hypovolemia/shock ++ Prognosis + • Recurrence after treatment is 20% ++ Prevention + • Proper hand washing and protective barrier (gown and gloves) with infected patients• Discontinue unnecessary antibiotics + Resources Print Section ++ References ++Bartlett JG, Gerding DN: Clinical recognition and diagnosis of Clostridium difficile infection. Clin Infect Dis 2008;46(Suppl 1):S12. ++Dallal RM et al: Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg 2002;235:363. [PubMed: 11882758] ++Hall JF, Berger D: Outcome of colectomy for Clostridium difficile colitis: a plea for early surgical management. Am J Surg 2008;196:384. [PubMed: 18519126] ++Nelson R: Antibiotic treatment for Clostridium difficileâassociated diarrhea in adults. Cochrane Database Syst Rev 2007;3:CD004610.