PROBIOTIC TREATMENT OF PSEUDOMEMBRANOUS COLITIS - COMBINATION OF INTESTINAL LAVAGE AND ORAL-ADMINISTRATION OF ESCHERICHIA-COLI

History and findings: An 82-year-old woman was admitted because of acu te left heart failure with pulmonary oedema. There was a right basal p neumonia with congestion which was treated with amoxycillin and clavul anic acid. Severe watery diarrhoea with more than 10 stools daily occu rred. Clostridium difficile was not isolated. Investigations: Coloscop y as far as the right flexure revealed proximally increasing whitish c oatings, like those in severe pseudomembranous colitis (PMC), revealed as acute erosive colitis histologically. The plate-like incomplete er osions contained fibrin and granulocyte deposits so typical of PMC. Cl ostridium difficile could again not be demonstrated. Treatment and cou rse: As intestinal lavage, already undertaken in preparation of the co loscopy, markedly improved the symptoms it was repeated for therapeuti c purposes. This brought about further improvement and a fall in granu locyte count from 29,500 G/I to 10,700 G/I. Subsequently live E. coli bacteria (nissle 1917 strain) were administered. After 5 days stool fr equency had fallen to one or two daily, each soft or partly formed. St ools were normal after a further week. Coloscopy 3 weeks after onset o f treatment showed almost complete healing of the PMC. Conclusion: The successful treatment of PMC with intestinal lavage and physiological E. coli administration agrees with the results of animal experiments a nd clinical experience. Whether it is an effective alternative to prim ary standard treatment with vancomycin or metronidazole remains to be tested by further experience, preferably properly controlled therapeut ic trials.