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Harrison's Principles of Internal Medicine, 18e
| Part 8. Infectious Diseases > Section 2. Clinical Syndromes. Community-Acquired Infections > |
Chapter 129. Clostridium Difficile Infection, Including Pseudomembranous Colitis
Sections: Clostridium Difficile Infection, Including Pseudomembranous Colitis: Introduction, Further Readings.
Topics Discussed: clostridium difficile infection; diarrhea, constipation, and irritable bowel syndrome.
Excerpt:"Clostridium difficile infection (CDI) is a unique colonic disease that is acquired almost exclusively in association with antimicrobial use and the consequent disruption of the normal colonic flora. The most commonly diagnosed diarrheal illness acquired in the hospital, CDI results from the ingestion of spores of C. difficile that vegetate, multiply, and secrete toxins, causing diarrhea and pseudomembranous colitis (PMC).When possible, discontinuation of any ongoing antimicrobial administration is recommended as the first step in treatment of CDI. Earlier studies indicated that 15–23% of patients respond to this simple measure. However, with the advent of the current epidemic strain and the associated rapid clinical deterioration of some patients, prompt initiation of specific CDI treatment has become the standard. General treatment guidelines include hydration and the avoidance of antiperistaltic agents and opiates, which may mask symptoms and possibly worsen disease. Nevertheless, antiperistaltic agents have been used safely with vancomycin or metronidazole for mild to moderate CDI...."
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