Antibiotic associated colitis

Abstract

It is a prospective study based on 100 consecutive cases of diarrhea following antibiotic therapy admitted to the pediatric services of J.N. Medical College, A.M.U., Aligarh between January to December 1987. They had C. penicillin (50), chloramphenicol (34), ampicillin (34), gentamicin (34), cephalosporin (4) and cotrimoxazole (4) for 3 days to 3 weeks prior to the onset of diarrhea. Apart from routine and special investigations, naked eye and microscopic examination of stool, its culture for pathogens including Cl. difficile were carried out in all cases. Presence of Cl. difficile cytotoxin was demonstrated by observing the cytopathic. Effect on veru cell culture, 18 grew Cl. difficile (14 cyto toxin positive). Frequency of fever, vomiting, abdominal distension, dehydration and duration of diarrhea was not different (p > 0.05) in the two groups. Purge rate and presence of mucus and blood in Cl. difficile positive patients was significantly higher (p < 0.05). Eight Cl. difficile positive (7 cytotoxin+ve) were subjected to endoscopy. Three of them showed P.M. colitis and 2 non specific colitis. Chloromycetin, gentamicin and penicillin were the main culprits responsible for AAC. None of the patients given ampicillin alone suffered from AAC. The mortality was 5%.

Co-infection as a confounder for the role of Clostridium difficile infection in children with diarrhoea: a summary of the literature

“…Studies included children aged 0-2 years (n=4), 0-5 years (n=2), 0-12 years (n=3) and 0-18 years (n= 22). The majority of studies were from North America (n=12; 6,184 cases) [13][14][15][16][17][18][19][20][21][22][23][24] and Europe (n=12; 2,467 cases) [8,[25][26][27][28][29][30][31][32][33][34][35], with other studies from Asia (n=4; 1,762 cases) [36][37][38][39], Australia (n=2; 148 cases) [40,41] and South America (n = 1; 210 cases) [42]. Ten studies included only community-onset patients [13,14,25,27,28,31,32,34,35,38], three included only hospital patients [20,30,40], 12 included both hospital and community [8, 15, 16, 19, 21-24, 26, 29, 33, 42] and six studies did not report the place of onset [17,…”

“…Albert et al analysed stool samples from 814 children with diarrhoea (aged 0-5 years), noting a coinfection in 53.8 % (7/13) of those with a positive C. difficile test (rotavirus, n=2; C. jejuni, n=1, enteropathogenic E. coli, n=1, enterotoxigenic E. coli, n=1, Aeromonas spp., n=1; Shigella spp., n=1) [37]. Twenty studies tested for bacterial co-infection in all samples [13,18,19,23,24,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41], 13 tested for viral pathogens (of which five tested for rotavirus only) [16, 18, 19, 23, 27-31, 33-35, 37] and six tested for parasites [23,30,32,33,37,40]. In ten studies, not all samples were tested for co-infection or no data were reported on the number of tested samples [8, 14, 15, 17, 20-22, 25, 26, 42].…”

Nosocomial Clostridium difficile-associated diarrhoea in Assiut University Children’s Hospital, Egypt

“…There were no statistically significant differences in any of the demographic or laboratory data between children with CDAD and those with other causes of nosocomial diarrhoea, which agrees with other studies. [42][43][44] Ten patients had severe symptoms (fever and/or bloody diarrhoea or abdominal distension or abdominal pain), but, fortunately, none of them developed complications such as sepsis, dehydration, electrolyte imbalance, paralytic ileus or toxic megacolon which might relate to early detection and appropriate management. Once CDAD was diagnosed, all antibiotics were stopped, and supportive fluid therapy and oral metronidazole were given to most of the children (13, 76.5%).…”

Antibiotic‐associated Bloody Diarrhea in Infants: Clinical, Endoscopic, and Histopathologic Profiles

“…It should be noted that there are no characteristic diagnostic features for AABD; the pattern of diarrhea together with the accompanying symptoms (eg, fever) is nonspecific and shared by other diseases such as bacterial infections, inflammatory bowel disease, and ischemic colitis (14). Furthermore, there is no relation between the pattern of AAD and its inducing mechanism with no reported differences between C difficile –positive and –negative children (15). Also, AAD shows no relation to the duration of antibiotic therapy, and symptoms may start even on the first day of intake (3).…”