Pseudomembranous colitis - An update

Clostridium difficile is the most common nosocomial infection of the gastro intestinal tract. Most cases are associated with antibiotic therapy that al ters the fecal flora, allowing overgrowth of C difficile with production of its toxins. Diagnosis is made by detection of the organism or toxin in the stools. A variety of different tests can be used, but none is perfect. A s tool culture can be positive in someone without diarrhea, ie, a carrier. Wh ile the cytotoxin is the gold standard, it is expensive, and there is a del ay before results are available. Thus, many laboratories use the enzyme lin ked immunoassay tests to detect toxin of C difficile because they are a mor e rapid screen. Depending on the specific test used, they can detect toxin A, toxin B or occasionally both. Sensitivity and specificity rates vary. Fi rst line therapy for C difficile disease should be metronidazole 250 mg qid for 10 days. Vancomycin should be reserved for severe cases where metronid azole has failed or where metronidazole cannot be tolerated or is contraind icated. Recurrent C difficile disease is a particularly vexing clinical pro blem. A variety of biotherapeutic approaches have been used. Retreatment wi th antibiotics is almost always necessary. In addition, the nonpathogenic y east Saccharomyces boulardii has been showed to be of benefit as an adjunct in preventing further recurrences.