Rifampicin-associated pseudomembranous colitis

Abstract

We report a case of pseudomembranous colitis that developed in a patient with liver cirrhosis during anti-tuberculosis therapy with rifampicin and isoniazid. The association between rifampicin and pseudomembranous colitis has been controversial; this report, however, supports the association. Colonoscopy performed 3 days after the onset of the pseudomembranous colitis revealed only reddish patches and a few aphthoid lesions, but 4 days later pseudomembranes were apparent. The pseudomembranous colitis was successfully controlled by discontinuation of the anti-tuberculosis agents, along with the administration of lactic acid bacteria, without vancomycin or metronidazole. Possible predisposing factors for the development of pseudomembranous colitis in this patient are also discussed.

Emergence of Clostridium difficile infection in tuberculosis patients due to a highly rifampicin-resistant PCR ribotype 046 clone in Poland

“…Agents such as isoniazid and pyrazinamide have little or no effect on the intestinal flora, but rifampicin has an antibiotic effect on a wide range of bacteria [17]. C .…”

Development of Pseudomembranous Colitis Four Months after Initiation of Rifampicin

“…Rare cases of rifampicin-associated PMC have been reported since the 1980s [3, 4, 5, 6, 7]. Among antitubercular agents, rifampicin has been implicated as a cause of PMC due to its relatively wide range of antibiotic effects, whereas isoniazid and ethambutol have few effects on the intestinal flora [3].…”

“…Among antitubercular agents, rifampicin has been implicated as a cause of PMC due to its relatively wide range of antibiotic effects, whereas isoniazid and ethambutol have few effects on the intestinal flora [3]. Most C. difficile strains are susceptible to rifampicin [8], but resistance can develop after prolonged use [9].…”

“…A long latency period is not unusual in rifampicin-associated PMC. Symptoms usually improve under treatment with vancomycin or metronidazole, and one patient was reported to recover after treatment with lactic acid bacilli only [3]. …”

“…Isoniazid and ethambutol have few effects on intestinal flora, but rifampicin has antibiotic effects over a wide range of bacteria [3] and therefore may cause PMC when PMC develops in association with antitubercular treatment. Here, we document a case of PMC that developed 4 months after initiation of rifampicin administration.…”