Antibiotic-Associated Colitis—C Difficile
(Antibiotic-associated Diarrhea, Clostridium difficile-induced Colitis, C diff)
Definition
Antibiotic-associated colitis is when the colon (large intestine) becomes inflamed due to an infection. You may have diarrhea and abdominal cramping. The infection is often very serious.
The Stomach, Liver, and Intestines
Causes
Your colon is normally full of good bacteria. When you take antibiotics, they often kill all the good bacteria in your intestine. This creates a perfect environment for bacteria called Clostridium difficile, which are not killed by the antibiotics, to grow out of control. The overgrowth of this bacteria leads to inflammation and irritation because C. difficile makes toxins that harm the lining of the intestine.
Risk Factors
A risk factor is something that increases your chances of getting a disease or condition. The following risk factors increase your chances of having this condition. If you have any of these risk factors, tell your doctor:
- You use antibiotics.
- You are elderly.
- You are or have been hospitalized or a long-term care resident.
- You have a severe illness.
Other possible risk factors include:
- Enteral feeding
- Taking medicine to decrease the amount of acid the stomach makes.
- Gastrointestinal surgery (stomach or intestine surgery) or gastrointestinal conditions, like Crohn’s disease or ulcerative colitis
- Pregnancy
- Chemotherapy
- Bone marrow transplant
Symptoms
If you have any of these symptoms, do not assume it is due to antibiotic-associated colitis. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your doctor.
- Loose stools
- Watery or mucousy diarrhea
- Abdominal pain
- Fever
- Nausea and vomiting (rare)
- Dehydration
- Low blood pressure
Diagnosis
Your doctor will ask about your symptoms and medical history, and do a physical exam. Tests may include:
- Stool samples —to identify the toxins made by the bacteria
- CT scan —a type of x-ray that uses a computer to make pictures of the inside of the body
- Colonoscopy —a thin, lighted tube inserted through the rectum and into the colon to examine the lining of the colon
Treatment
If you are diagnosed with this condition, follow your doctor's instructions .
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Fluid Replacement
The first step is to stop taking the antibiotic and replace lost fluids. Talk with your doctor first before stopping the antibiotic. The colitis usually goes away within two weeks of stopping the antibiotic.
Medications
You may be given antibiotics that kill C. difficile. You may also be given probiotics which help get the normal bacteria back into your colon.
Try not to use antidiarrheal drugs (eg, loperamide and opiates).
Surgery
In very rare cases you may need surgery. A surgeon may connect your small intestine to an opening in your abdomen. This will divert stool from your large intestine and rectum. This surgery is called an ileostomy. Or the surgeon could remove your large intestine. This is called a colectomy.
Prevention
The best way to prevent this condition is to reduce using antibiotics. Antibiotics should only be used when your doctor has confirmed that you have a bacterial infection.
If you are prescribed antibiotics, ask your doctor if you should take a probiotic also, which may help protect the normal bacterial growth in your intestines.
Crohn’s and Colitis Foundation of America
National Digestive Diseases Information Clearinghouse
Canadian Association of Gastroenterology
Canadian Digestive Health Foundation
Antibiotic-associated colitis. Merck website. Available at: http://www.merck.com/mmhe/sec09/ch127/ch127a.html. Accessed November 30, 2006.
Antibiotic-associated diarrhea. DynaMed website. Available at: http://dynamed102.epnet.com/Detail.aspx?id=114443. Accessed November 30, 2006.
Antibiotic-associated diarrhea. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/antibiotic-associated-diarrhea/DS00454. Accessed November 30, 2006.
Clostridium difficile colitis. DynaMed website. Available at: http://dynamed102.epnet.com/Detail.aspx?style=1&docid=/dynamed/39bebcddd7cbdbe2852562be006077d5. Accessed November 30, 2006.
Heinlen L, Ballard JD. Clostridium difficile infection. Am J Med Sci. 2010 Sep;340(3):247-52.
Hensgens MP, Goorhuis A, Notermans DW, van Benthem BH, Kuijper EJ. Changing epidemiology of infections in the Netherlands in 2008/09. Ned Tijdschr Geneeskd. 2010;154:A1317.
Navaneethan U, Venkatesh PG, Shen B. Clostridium difficile infection and inflammatory bowel disease: understanding the evolving relationship. World J Gastroenterol. 2010 Oct 21;16(39):4892-904.
Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile -associated disease. JAMA. 2005 Dec 21;294(23):2989-95.
Last reviewed December 2011 by Rosalyn Carson-DeWitt, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
