Antibiotic-associated colitis
Antibiotic-associated colitis is a condition characterized by inflammation of the colon due to an infection, with symptoms that may include diarrhea, abdominal cramping, nausea, and fever. This condition often arises after the use of antibiotics, which can disrupt the balance of healthy bacteria in the intestine, allowing the bacterium Clostridium difficile to proliferate. Individuals at higher risk include older adults, those with severe illnesses or existing gastrointestinal conditions, and patients who have undergone surgery or chemotherapy. Diagnosis typically involves a medical history review, physical examination, and tests such as stool samples or imaging studies.
Treatment usually focuses on ceasing the use of the implicated antibiotic and may involve fluid replacement and specific antibiotics to target C. difficile. Probiotics may also be recommended to restore beneficial bacteria. In severe cases, surgical interventions like colectomy or ileostomy might be necessary. Preventive measures emphasize the judicious use of antibiotics, ensuring they are only taken when prescribed for confirmed bacterial infections. Overall, understanding this condition is crucial for managing risk factors and recognizing symptoms early for effective treatment.
Antibiotic-associated colitis
- ANATOMY OR SYSTEM AFFECTED: Abdomen, colon, gastrointestinal system, intestines, stomach
- ALSO KNOWN AS: Antibiotic-associated diarrhea, Clostridium difficile-induced colitis, Clostridium difficile infection, Pseudomembranous colitis
Definition
Antibiotic-associated colitis occurs when the colon (the large intestine) becomes inflamed because of an infection. The infected person might have diarrhea and abdominal cramping, and the infection is often serious.
Causes
The colon is normally full of good bacteria. Antibiotics, however, often kill all the good bacteria in the intestine, creating a perfect environment for the bacterium Clostridium difficile, which is not killed by the antibiotics, to grow out of control. The overgrowth of C. difficile leads to inflammation and irritation.
Risk Factors
Risk factors that increase a person’s chances of having this condition include the use of antibiotics. Other possible risk factors include enteral feeding (tube feeding), taking medicine to decrease the amount of acid the stomach makes, gastrointestinal surgery (stomach or intestine surgery), chemotherapy, and bone marrow transplant. Persons at higher risk include older individuals, persons who are or have been hospitalized, and persons with a severe illness. Individuals who are immunocompromised or have an existing colon condition are also at an increased risk.
Symptoms
Having the following symptoms does not always mean a person has antibiotic-associated colitis. These symptoms may be caused by other, less serious health conditions. If the following symptoms do appear, one should see a doctor: loose stools, watery diarrhea or diarrhea with mucus, abdominal pain, fever, nausea and vomiting, dehydration, and low blood pressure.
Screening and Diagnosis
A doctor will ask about symptoms and medical history and do a physical exam. Tests may include stool samples (to identify the toxins made by the bacteria), a computed tomography (CT) scan (a detailed X-ray that identifies abnormalities of fine tissue structure), and a colonoscopy (a thin, lighted tube inserted through the rectum and into the colon to examine the lining of the colon).
Treatment and Therapy
If diagnosed with this condition, one should follow the doctor’s instructions and consult them about the best treatment plan. Treatment options include fluid replacement, in which the first step is to stop taking the antibiotic and to replace lost fluids. However, one should consult the doctor before stopping the antibiotic. The colitis usually disappears within two weeks of stopping the antibiotic.
Another treatment option is medication, such as antibiotics that kill C. difficile. Fidaxomicin or oral vancomycin are recommended as first-line treatments. Also useful are probiotics (good bacteria), which help to replace normal bacteria in the colon. Furthermore, one should not use antidiarrheal drugs such as loperamide and opiates.
In rare cases, the infected person may need surgery, during which a surgeon would connect the small intestine to an opening in the abdomen. This will divert stool from the large intestine and rectum. This surgery is called an ileostomy. Alternatively, the surgeon could remove the large intestine. This surgery is called a colectomy.
Prevention and Outcomes
The best way to prevent this condition is to reduce the use of antibiotics. One should use antibiotics only when a doctor has confirmed a bacterial infection. Persons who are prescribed antibiotics should consult the doctor about also taking a probiotic, which may help protect the normal bacterial growth in the intestines.
Bibliography
Bäckhed, Fredrik, et al. "Host-Bacterial Mutualism in the Human Intestine." Science, vol. 307, 25 Mar. 2005, pp. 1915-1920.
Bartlett, John G., and Dale N. Gerding. "Clinical Recognition and Diagnosis of Clostridium Difficile Infection." Clinical Infectious Diseases, vol. 46, no. Supplement‗1, 2008, pp. S12-S18, doi.org/10.1086/521863. Accessed 9 Nov. 2024.
Feldman, Mark, Lawrence S. Friedman, and Lawrence J. Brandt, editors. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. New ed., 2 vols., Saunders/Elsevier, 2010.
Peikin, Steven R. Gastrointestinal Health. Rev. ed., Quill, 2001.
"Pseudomembranous Colitis - Symptoms & Causes." Mayo Clinic, 14 Dec. 2022, www.mayoclinic.org/diseases-conditions/pseudomembranous-colitis/symptoms-causes/syc-20351434. Accessed 9 Nov. 2024.
Salen, Philip and Holly A. Stankewicz. "Pseudomembranous Colitis - StatPearls." NCBI, 8 Aug. 2023, www.ncbi.nlm.nih.gov/books/NBK470319. Accessed 9 Nov. 2024.
"Use of Gastric Acid-Suppressive Agents and the Risk of Community-Acquired Clostridium difficile-Associated Disease." Journal of the American Medical Association, vol. 294, no. 23, 21 Dec. 2005, pp. 2989-2995.