Management of Severe C difficile Colitis

Severe, life threatening C. difficile colitis requiring an intensive care unit admission occurs in 1 to 3% of patients. These patients often develop high fever, leukocytosis, peritoneal signs, abdominal distention, and progressive signs of sepsis. Based on anecdotal reports of a slightly more rapid response rate, the recommended first line therapy for fulminant C. difficile infection is vancomycin. However, in patients unable to tolerate oral antibiotics or nasogastric delivery and in patients with an ileus, IV metronidazole may be the only available option. Additionally, in critically ill patients, combinations of antibiotics should be considered. One study demonstrated responses in 6 of 8 patients with severe C. difficile infection who received IV metron-idazole plus vancomycin delivered via a nasogastric tube and retention enemas (Olson et al, 1994).

Based on findings of low serum and fecal concentrations of antibodies to C. difficile toxins in patients with severe or refractory C. difficile diarrhea, it was hypothesized that some patients may benefit from passive immunization with immunoglobulin products (Kyne at al, 2001). Case reports have documented clinical resolution in patients with severe and refractory pseudomembranous colitis following treatment with IV delivery of normal, pooled human immunoglobulin. Although this approach appears promising, controlled trials are required before recommending IV gamma globulin therapy for all patients with severe C. difficile-associated colitis.

In patients with fulminant colitis or those with progressive toxic megacolon, surgery to avert bowel perforation may be the only option to prevent death. The current most effective surgical procedure for this condition is a subtotal colectomy. Making the decision of whether and when to perform surgery is difficult due to a high mortality rate (> 40%) associated with emergent surgery for C. difficile-associated colitis.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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