Pseudomembranous colitis

Pseudomembranous colitis refers to swelling or inflammation of the large intestine (colon) due to an overgrowth of Clostridioides difficile (C difficile) bacteria.

This infection is a common cause of diarrhea after antibiotic use. Not all cases of diarrhea associated with antibiotic use are due to C difficile or will progress to pseudomembranous colitis.

Causes

The C difficile bacteria normally lives in the intestine. However, too much of these bacteria may grow when you take antibiotic medicines. The bacteria give off a strong toxin that causes inflammation and bleeding in the lining of the colon.

Any antibiotic can cause this condition. The medicines responsible for the problem most of the time are ampicillin, clindamycin, fluoroquinolones, and cephalosporins.

Health care providers in the hospital may pass this bacteria from one patient to another.

Pseudomembranous colitis is uncommon in children, and rare in infants. It is most often seen in people who are in the hospital. However, it is becoming more common in people who take antibiotics and are not in a hospital.

Risk factors include:

• Older age
• Antibiotic use
• Use of medicines that weaken the immune system (such as chemotherapy medicines)
• Recent surgery
• History of pseudomembranous colitis
• History of ulcerative colitis, Crohn disease, and inflammatory bowel disease (IBD). C difficile can happen in IBD patients even without taking antibiotics.

  Ulcerative colitis

  Ulcerative colitis is a condition in which the lining of the large intestine (colon) and rectum become inflamed. It is a form of inflammatory bowel ...

  

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  Crohn disease

  Crohn disease is a disease where parts of the digestive tract become inflamed. It most often involves the lower end of the small intestine and the be...

  

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Symptoms

Symptoms include:

• Abdominal cramps (mild to severe)

  Abdominal cramps

  Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.

  

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• Bloody stools

  Bloody stools

  Black or tarry stools with a foul smell are a sign of a problem in the upper digestive tract. It most often indicates that there is bleeding in the ...

  

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• Fever
• Urge to have a bowel movement
• Watery diarrhea (often 5 to 10 times per day)

  Diarrhea

  Diarrhea is when you pass loose or watery stool.

  

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Exams and Tests

The following tests may be done:

• Colonoscopy or flexible sigmoidoscopy

  Colonoscopy

  A colonoscopy is an exam that views the inside of the colon (large intestine) and rectum, using a tool called a colonoscope. The colonoscope has a sm...

  

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• Immunoassay for C difficile toxin in the stool

  C difficile toxin

  The stool C difficile toxin test detects harmful substances produced by the bacterium Clostridioides difficile (C difficile). This infection is a co...

  

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• Polymerase chain reaction (PCR) for C difficile toxin in the stool
• CT scan if complications are suspected

Treatment

The antibiotic or other medicine causing the condition should be stopped. Fidaxomicin and vancomycin are most often used to treat the problem. Metronidazole is also effective, but it is no longer a first line choice in the US.

Electrolyte solutions or fluids given through a vein may be needed to treat dehydration due to diarrhea. In rare cases, surgery is needed to treat infections that get worse or do not respond to antibiotics.

Long term antibiotics may be needed if the C difficile infection returns. A treatment called fecal microbiota transplant ("stool transplant") has also been effective for infections that come back.

Your provider may also suggest that you take probiotics if the infection returns.

An antibody treatment may be needed in patients with very high risk of recurrent C difficile to lessen the risk of recurrence. 

Outlook (Prognosis)

The outlook is good in most cases, if there are no complications. However, up to 1 in 5 infections may return and need more treatment.

Possible Complications

Complications may include:

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

  Toxic megacolon

  Toxic megacolon occurs when swelling and inflammation spread into the deeper layers of your colon. As a result, the colon stops working and widens. ...

  

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• Death

When to Contact a Medical Professional

Contact your provider if you have the following symptoms:

• Any bloody stools (especially after taking antibiotics)
• Five or more episodes of diarrhea per day for more than 1 to 2 days
• Severe abdominal pain
• Signs of dehydration

Prevention

People who have had pseudomembranous colitis should tell their providers before taking antibiotics again. It is also very important to wash hands well to prevent passing the germ to other people. Alcohol sanitizers do not always work on C difficile.