Pseudomembranous Colitis

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This condition is caused by Clostridium difficile, a gram positive, anaerobic bacterium causing  antibiotic associated diarrhoea as a result of altered bacterial flora and release of enterotoxins. 

Clinical presentation 

• Bloody Diarrhea
• Abdominal cramps and tenderness
• Nausea, fever, dehydration

Investigations

• Lower endoscopic pathognomonic findings of pseudomembranous yellowish plaques overlying the ulcerated and friable rectal sigmoid colon mucosa
• Laboratory evidence of C. difficile toxin A-B isolation from cultured stool samples (Toxin B) OR ELISA assay (Toxin A)

Pharmacological Treatment  Stop the causative antibiotics 

A: metronidazole (PO) 400mg 8hourly for 10-14days 

OR 

S: vancomycin (PO) Adults, 125mg–500mg 6hourly for 10-14days 

Note: Resuscitative and supportive management should be instituted as for Ulcerative Colitis (UC). Refer to next level of care with adequate expertise and facilities for all suspected cases for initial  evaluation and management and cases presenting with acute complications such as Toxic megacolon