Management of antibiotic related and clostridium difficile colitis

Nearly all antibiotics can cause some form of diarrhoea. Clostridium difficile infection has become an important area in our daily clinical practice and is known to cause a broad spectrum of conditions ranging from asymptomatic carriage to the life-threatening pseudomembranous colitis (PMC), with toxic megacolon and ileus. Patients most at risk are those who have been treated with broad spectrum antibiotics, those with serious underlying co-morbidities and the elderly. Over 80% of Clostridium difficile infection reported are in people aged over 65 years. Combination of rapid and accurate diagnosis will result in a better management of Clostridium difficile infection. Discontinuation of causative agents such as antibiotic treatment is often curative. In more serious cases, oral administration of metronidazole or vancomycin is the treatment of choice. Patients should be treated promptly when the diagnosis of Clostridium difficile colitis is made to avoid sepsis or bowel perforation. Relapses of Clostridium difficile infection have been reported in about 20-25% of cases, this may increase to 45-60% after the first recurrence on. In some cases colectomy may improve the outcome of the patient with systemic infection or complicated Clostridium difficile colitis. This article reviews the current literature regarding epidemiological picture, microbiology, histopathology and both medical and surgical managements.