Diarrhoea and Colitis Associated with Antibiotic Treatment: A Report of 16 cases

Gibson, G. E.; Rowland, R.; Hecker, Robert

doi:10.1111/j.1445-5994.1975.tb03269.x

Cited by 22 publications

(7 citation statements)

References 15 publications

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“…3), is the earliest recognisable abnormality on which to make a positive diagnosis of pseudomembranous colitis. It is well illustrated in other papers and is not simply an artefact of sectioning (as serial sections in this study have shown) Gibson et al, 1975;Steer, 1975). It occurs immediately beneath the surface epithelium between the glandular openings.…”

Section: Histopathologysupporting

confidence: 77%

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Pseudomembranous colitis.

Ab¹,

Davies²

1977

J Clin Pathol

229

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Three basic histopathological patterns which may be seen in rectal biopsies from patients with pseudomembranous colitis are described, based on a study of 29 cases. The spectrum of change is illustrated and the problems of differential diagnosis are discussed--from a non-diagnostic proctitis at one extreme to acute ischaemia at the other. In the differential diagnosis of the acute colitic, the importance of urgent rectal biopsy and a carefully taken drug history is stressed. The association of pseudomembranous colitis with pre-existing disease and antibiotic therapy is confirmed. It is suggested that these cause local mucosal damage and may trigger the first part of a local Shwartzman reaction. Capillary microthrombosis may then paly a part in producing the mucosal necrosis seen later in the disease.

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Section: Histopathologysupporting

confidence: 77%

“…It is questionable whether all 'antibiotic induced (Gibson et al, 1975). If one excludes proven infective lesions, such as staphylococcal colitis, it is possible that this is the case.…”

Section: Clinical Featuresmentioning

confidence: 99%

Pseudomembranous colitis.

Ab¹,

Davies²

1977

J Clin Pathol

229

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“…It is well established that certain patients who receive antibiotics develop diarrhoea (Tedesco, 1975); it is not known if there are any mucosal abnormalities at this stage. A minority of patients in this 'susceptible' state go on to develop a definite colitis which is either nonspecific or pseudomembranous in type (Gibson et al, 1975). It is in the latter group that C. difficile is found in the gut.…”

Section: Discussionmentioning

confidence: 99%

Morphology of experimental antibiotic-associated enterocolitis in the hamster: a model for human pseudomembranous colitis and antibiotic-associated diarrhoea.

Ab¹,

Larson²,

Crow³

1979

Gut

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SUMMARYThe morphology of antibiotic-associated enterocolitis in the hamster is described and compared with human antibiotic-associated pseudomembranous colitis. It is shown to be a caecal disease with proliferative mucosal changes and in this respect unlike the human counterpart. The bacteriology and toxicology, however, are identical. In addition, mucosal changes are described in animals on antibiotics but without established enterocolitis. As a result we suggest that there may be a spectrum of human disease ranging from mild antibiotic-associated diarrhoea to established pseudomembranous colitis. Therefore, despite the morphological variation, the hamster remains a good model for investigating the pathogenesis of pseudomembranous colitis and antibiotic-associated enteropathy in general. al., 1978b;Larson et al., 1978) since then have confirmed these findings and demonstrated cross-neutralisation between the toxin of C. difficile and C. sordellii antitoxin (George et al., 1978a). It seems established that proliferation of toxigenic strains of C. difficile in the human bowel is one mechanism in the pathogenesis of pseudomembranous colitis.In parallel with the findings in humans similar results have been produced in Syrian golden hamsters. Small (1968) initially demonstrated that lincomycin produced a fatal enterocolitis when given to hamsters. Because lincomycin and the related clindamycin have been the antibiotics at the centre of a spate of reports on antibiotic-associated pseudomembranous colitis (Cohen et al., 1973;Scott et al.,

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“…Until 1970, only a few publications discussed the surgical management of C. difficile disease, and diversion was commonly used [73,79,108,182,184,[186][187][188][189][190]. This Surgical Treatment Indications for surgery include complicated or severe resulted in a high mortality rate of 66% since the diseased organ was not removed [17].…”

Section: Medical Treatmentmentioning

confidence: 99%

<i>Clostridium difficile </i>Infection: Risk Factors, Medical and Surgical Management

Klingler¹,

Metzger²,

Seelig³

et al. 2000

Dig Dis

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Background:Clostridium difficile has become recognized as a cause of nosocomial infection which may progress to a fulminant disease. Methods: Literature review using electronic literature research back to 1966 utilizing Medline and Current Contents. All publications on antibiotic-associated diarrhea, antibiotic-associated colitis, and pseudomembranous colitis as well as C. difficile infection were included. We addressed established and potential risk factors for C. difficile disease such as an impaired immune system and cost benefits of different diagnostic tests. An algorithm is outlined for diagnosis and both medical and surgical management of mild, moderate and severe C. difficile disease. Results: Diagnosis of C. difficile infection should be suspected in patients with diarrhea, who have received antibiotics within 2 months or whose symptoms started after hospitalization. A stool specimen should be tested for the presence of leukocytes and C. difficile toxins. If this is negative and symptoms persist, stool should be tested with ‘rapid’ enzyme immunoabsorbent and stool cytotoxin assays, which are the most cost-effective tests. Endoscopy and other imaging studies are reserved for severe and rapidly progressive courses. Oral metronidazole or vancomycin are the antibiotics of choice. Surgery is rarely required for selected patients refractory to medical treatment. The threshold for surgery in severe cases with risk factors including an impaired immune system should be low. Conclusion:C. difficile infection has been recognized with increased frequency as a nosocomial infection. Early diagnosis with immunoassays of the stool and prompt medical therapy have a high cure rate. Metronidazole has supplanted oral vancomycin as the drug of first choice for treating C. difficile infections.

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Diarrhoea and Colitis Associated with Antibiotic Treatment: A Report of 16 cases

Cited by 22 publications

References 15 publications

Pseudomembranous colitis.

Pseudomembranous colitis.

Morphology of experimental antibiotic-associated enterocolitis in the hamster: a model for human pseudomembranous colitis and antibiotic-associated diarrhoea.

<i>Clostridium difficile </i>Infection: Risk Factors, Medical and Surgical Management

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