Clostridium Difficile(Antibiotic Diarrhea) |
| Antibiotics are medications that kill bacteria. Since their discovery over fifty years ago, antibiotics have certainly been a key factor in keeping us healthy. Their ability to fight infection has saved countless lives. But, there is a downside as well. As with all powerful medications, side effects may sometimes occur. Often, this will take the form of an allergic reaction such as a skin rash. Another side effect that is less well recognized is diarrhea. This is often called antibiotic-associated diarrhea. Other names for this condition are antibiotic-associated colitis, pseudomembranous colitis, or Clostridium difficile colitis. |
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| Good Versus Evil |
The problem is one of imbalance. The colon, or large intestine, normally contains trillions of bacteria that live and multiply happily in your colon. In fact, there are more intestinal bacteria in your colon at this moment than there are human beings who have ever lived. Most of these are considered "healthy bacteria." They do not bother you and you don't bother them. All is in balance. A small percentage of these bacteria are harmful - but they are kept in check by all of the healthy bacteria.
A good analogy would be your lawn. If your lawn is healthy, it has few weeds. The thick blades of grass suppress any weeds. But if there is a drought and your grass thins out, weeds will take over. In your colon, the normal healthy bacteria suppress any disease causing germs. However, sometimes when you take antibiotics, the number of healthy bacteria decreases, thus allowing harmful bacteria an opportunity to flourish.
There happens to be a certain harmful bacteria called Clostridium difficile which may normally be present in small numbers. If antibiotics sufficiently suppress the healthy bacteria, the Clostridium difficile organism is allowed to multiply. It may then produce a toxic substance that causes diarrhea. In high concentrations, this toxin may actually damage the wall of the colon - sometimes severely. |
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| Which Antibiotics Cause This Problem? |
| Each antibiotic has a different chemical structure which affects the way it works in the body. Some are more powerful than others, but any antibiotic can suppress the healthy bacteria in your colon. Usually this problem surfaces when the newer, more powerful antibiotics are prescribed, or when multiple antibiotics are used for serious infections. The risk of antibiotic associated diarrhea also rises with how often and how long the antibiotics are taken. However, even the most gentle antibiotics, given for a short period of time, can occasionally lead to this problem. |
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| How Soon Do Symptoms Occur? |
| Again there is much variation. Antibiotic associated diarrhea can occur within two days of completing a course of antibiotics or even up to six weeks later. Therefore, if you have new symptoms of diarrhea, it is important that you make your doctor aware of any antibiotics you may have taken in the last several months. |
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| What Are The Symptoms? |
| Most patients with this problem notice an unexplained change in bowel habit. The stools become less formed, often loose and watery. There may be nausea, fever, and abdominal pain in severe cases. There is often much urgency with the bowel movement and an unusually foul odor. |
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| How Is This Condition Diagnosed? |
| Since antibiotic-associated diarrhea is secondary to the damaging effects of a toxin produced by the Clostridium difficile organism, the diagnosis can usually be made by looking for the presence of this toxin in a fresh stool specimen. In severe cases, the lining of the colon may actually be damaged and a flexible sigmoidoscopy (short scope) or colonoscopy (full scope) test may be helpful in making the diagnosis and assessing the degree of damage |
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| How Is This Condition Treated? |
The most important aspect of treatment would be to limit the use of powerful antibiotics, particularly when the symptoms of diarrhea occur. By stopping the offending antibiotics under the supervision of your doctor, the normal healthy intestinal bacteria can again multiply and repopulate the colon. In more severe cases, one of two special antibiotics may be prescribed. These antibiotics have the opposite effect. They selectively kill the Clostridium difficile organism allowing the normal bacteria to flourish. The most commonly prescribed antibiotic is Flagyl (metronidazole). This can be given orally or in severe cases, by vein. A more expensive antibiotic is Vancocin (vancomycin) which is given orally in the most severe cases.
Of course, another important aspect of therapy would be to correct any dehydration which has occurred because of the diarrhea. It is important, however, to avoid antidiarrheal medications since diarrhea is basically nature€s way of purging the toxin from the colon. If antidiarrheal medications are taken, this allows the toxin to remain in the colon for prolonged periods of time, thus worsening the situation.
There may also be some benefit in using Lactobacillus bacteria which is found in acidophilus milk or any yogurt with active culture. Evidence suggests that such products may help repopulate the colon with normal, healthy bacteria and speed recovery.
In an institutionalized setting, such as a hospital, it is also important to prevent the spread of this Clostridium difficile bacteria since it is present in the diarrheal stools. The bacteria can form a spore which may remain infectious despite the use of conventional disinfectants. The spore can survive extreme environmental conditions and persist for months or years outside the body. |
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| How Can I Prevent This Problem? |
While there is no guaranteed way to prevent antibiotic associated diarrhea, some simple measures are helpful. The most obvious would be to avoid the unnecessary use of antibiotics for simple infections. Have you ever asked your doctor for antibiotics to treat a cold or the flu? These viral infections do not respond to antibiotics, yet antibiotics are often requested. They should not be utilized. You should tell your doctor if you have ever had Clostridium difficile colitis since past episodes increase your risk of future attacks
Another preventative measure, particularly within institutions such as hospitals and nursing homes, is the isolation of patients who harbor this infection and careful handwashing and other hygiene techniques.
Lastly, early diagnosis is best. If you have recently received antibiotics and have a significant change in bowel habit, you should see your doctor earlier rather than later since if untreated, late stages of this disease can be quite devastating and occasionally requires surgical removal of the colon. |
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| What About The Future? |
| As the use of antibiotics increases, the incidence of Clostridium difficile infection escalates. The future hope is that a vaccine will become available to immunize high-risk patients. Much research is being done in this area since Clostridium difficile infections are quite costly in today's health care system If you have any additional questions about this condition, you should discuss this with your physician. |
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| Remember... |
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| Don't insist on a prescription for an antibiotic if you have a viral infection such as a cold or flu. |
| Follow your doctor's instructions carefully. Take doses on schedule for the number of days indicated. |
| Let you doctor know if you develop symptoms of persistent diarrhea during or within 6 weeks after a course of antibiotics. |
| Never share your antibiotics with anyone. If you have any left over, throw them away. |
| As with all medications, keep your antibiotics out of children's reach. |
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