Decompressive colonoscopy with intracolonic vancomycin administration for the treatment of severe pseudomembranous colitis

Shetler, Katerina; Nieuwenhuis, R F; Wren, Sherry M.; Triadafilopoulos, George

doi:10.1007/s004640080104

Cited by 55 publications

(44 citation statements)

References 31 publications

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“…Similarly, Shetler and colleagues have claimed that colonoscopic decompression along with adjunctive ICV can be used in treatment of severe pseudomembranous colitis [68].…”

Section: Discussionmentioning

confidence: 99%

“…Treating with oral or intravenous antimicrobial regimens has been shown to be unsuccessful mainly due to inadequate concentration of the drug in the colon [57][58][59]. There is some evidence available that adding intra colonic vancomycin, as an alternative route, can be promising as in 57%-75% of patients [60,[61][62][63][64][65][66][67][68][69][70]. Intravenous metronidazole, in some circumstances, produces fecal concentrations greater than the MIC needed for C. difficile; therefore, it may be an effective therapy [71].…”

Section: Discussionmentioning

confidence: 99%

“…Intravenous metronidazole, in some circumstances, produces fecal concentrations greater than the MIC needed for C. difficile; therefore, it may be an effective therapy [71]. However, the efficacy of intravenous metronidazole therapy still remains debatable, since its excretion occurs mostly in the upper parts of gastrointestinal tract and as low as 14% of each intravenously administered dose is excreted in the feces [68].…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, addition of ICV, administered by rectal enema or long catheters, is an alternative regimen especially in severely ill patients who have not responded to first-line therapy or are not eligible for it [60,[61][62][63][64][65][66][67][68][69][70].…”

Section: Discussionmentioning

confidence: 99%

“…There are several concerns regarding the delivery of ICV to the transverse and ascending colon [60,[61][62][63][64][65][66][67][68][69][70]. Inadequate delivery of ICV to the proximal colon is a contributory factor in treatment failure of some cases.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Pseudomemberanous Colitis following Cesarean Delivery with Adjunctive Intracolonic Vancomycin

Ahmadi¹,

Rezaee²,

Tanha³

et al. 2016

J Gynecol Res Obstet

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Journal of Gynecological Research and Obstetrics 055According to the operation report numerous adhesions were detected during surgery, many of which especially those in the uterine incision site had been released. The patient received one dose of prophylactic cefazolin after clamping of the umbilical cord. Before discharge (discharged with personal consent) she had gas passage and defecation.Three days after C/S the patient was hospitalized with a presumed ileus. At that point she seemed well and had no fever and tachycardia; the abdomen was distended; bowel sounds were normal. On palpation, tenderness in left lower quadrant without rebound was present. In chest auscultation no abnormal finding except dextrocardia was detected (Figures 1,2).Initially the patient was managed conservatively, laboratory tests and surgery consult were ordered.The patient was not allowed to take anything by mouth and it was well emphasised to her to stay mobile. Despite gas passage her abdominal distention fluctuated during the first two days of hospitalization. During this period the laboratory findings were normal, no leucocytosis was present and hemoglobin and electrolytes were normal. Just on abdominal x ray( upright and flat) hyperinflation was to be seen.After the second day, diarrhea and a 38 C fever were added to the patients' signs. The diarrhea contained greenish liquid with white cheese -like parts. The patient was not ill, the abdominal palpation revealed no change and the laboratory findings were still normal.On the third day, abdominal distention was noticeably increased and the abdomen became tenser. Emergent surgery and gastrointestinal consult were ordered and the patient was admitted to the intensive care unit. At that point potassium was as low as 2.4 IntroductionPseudomembranous colitis (PMC) is a type of colitis (and sometimes enteritis), with special pathologic and oftentimes radiologic features, which is usually associated with the overgrowth of a bacterium called Clostridium difficile. Although this condition normally occurs following antibiotic consumption, it may rarely happen in other settings such as bowel ischemia, intestinal obstruction, and intestinal surgery or chemotherapy. Moreover, gastrointestinal infections (e.g. Staphylococcus aureus) can induce a similar condition [1].A recent increase in the incidence rate and severity of clostridium difficile infection has been reported, which is thought to be due to the great use of broad spectrum antibiotics worldwide and the development of a hypervirulant strain of this organism [2][3][4]. The presentation of PMC can vary from a self-limiting diarrhea to toxic megacolon and death [5]. Yet, many cases have confusing clinical features and their condition may not be diagnosed immediately [1]. History of previous antibiotic intake especially cephalosporins and flouroquinolones is the most important risk factor for PMC [6][7][8]. This risk is at its peak within the first month after antibiotic use [9].Immediate diagnosis and treatment of this condition can decre...

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“…Similarly, Shetler and colleagues have claimed that colonoscopic decompression along with adjunctive ICV can be used in treatment of severe pseudomembranous colitis [68].…”

Section: Discussionmentioning

confidence: 99%