Exxcellence pearls: clostridium difficile colitis

Question 1

Define acute diarrhea.

Answer 1

Three mostly loose or watery stools a 24-hour interval.

Question 1

What are risk factors for Clostridium difficile infection?

Answer 1

Extremes in age, prolonged hospitalization, living in a nursing home.

Question 2

What is the broad differential diagnosis for acute diarrhea?

Answer 2

Infection, bowel stimulants such as magnesium containing antacids or proton pump inhibitors, dietary intolerance such as lactose or gluten, inflammatory bowel disease, malabsorption.

Question 3

What is the concerning complication of Clostridium difficile infection?

Answer 3

Pseudomembranous colitis which can progress to necrotizing colitis and bowel perforation.

Question 4

How is Clostridium difficile diagnosed?

Answer 4

Stool culture and the presence of enterotoxin in the stool.

Question 5

How is Clostridium difficile diarrhea treated?

Answer 5

Discontinue the inciting anabiotic.

Metronidazole 250-500 mg TID or QID for 7-10 days.

Question 7

What is the rate of recurrence?

How should this be treated?

Answer 7

15-20%

Metronidazole for 21 days or oral vancomycin 125-500 mg Q6 hours for 10 days.

Fulminant or intractable disease can be treated by IV metronidazole with oral vancomycin.