Pseudomembranous colitis: treatment

Approaches to the treatment of pseudomembranous colitis and diarrhea caused by C. Difficile are generally similar in adults and children, but there are certain differences that allow them to be considered separately in adults and children.

Adults If this is possible, then the antibiotic that could be the cause of colitis should be canceled. In the case of an average current, this is usually sufficient. Improvement of the condition is observed already 48 hours after the abolition of the antibiotic, and diarrhea ends a few days later. In more severe cases, additional treatment is necessary. High concentrations of the drug active against C. Difficile in the intestine are achieved with its administration inside or into the probe. If the use of antibacterial therapy is required to treat infectious processes of other localization, the antibiotic active against C. Difficile is included in combined antibacterial therapy.

[1], [2], [3], [4], [5], [6], [7], [8]

Treatment of pseudomembranous colitis in mild and medium severe

Usually appoint metronidazole at a dose of 250 mg 4 times a day for 10-14 days. The cost of vancomycin for oral administration is much higher, in addition, this form has never been imported into the Russian Federation. Therefore, the ingestion of a solution of the drug intended for intravenous administration in the same dosage as inside is recommended. Widespread use of the drug inside may lead to an increase in the resistance of enterococci to vancomycin. That is why with a mild course of preference give metronidazole.

Treatment of pseudomembranous colitis in severe course

In the case of a very severe or life-threatening course of infection, many specialists recommend using vancomycin in a dose of 125 mg 4 times a day for 10-14 days. There is a general consensus on the need to reduce the consumption of vancomycin because of the high probability of increasing the resistance of enterococci.

Bacitracin

Apply in a dose of 25 000 units or 500 mg 4 times a day for 10-14 days instead of metronidazole and vancomycin. Clinical efficacy is significantly lower. In addition, in the form for oral administration of the drug in the Russian Federation there.

When it is not possible to take the medication internally, the optimal regimen is unknown. Preliminary data indicate the benefits of intravenous metronidazole (500 mg at 6 hours) compared with vancomycin, which is important in patients with intestinal obstruction. In addition, vancomycin is administered orally via a probe, ileostomy, colostomy or in an enema at a higher dose than usual (500 mg after 6 hours). It is usually recommended to determine the level of vancomycin in the blood plasma to avoid overdose.

Kolestyramine

Applied with medium-severe disease It is able to bind toxin B and, possibly, toxin A, thereby reducing their biological activity. Because of its ability to bind vancomycin, their combined use is not recommended.

[9], [10], [11], [12], [13], [14]

Lactobacillus acidophilic

The role of lactobacilli as a replacement therapy is unclear, so they are not recommended.

Opiates and drugs with antiperistaltic action

Preparations of these groups are contraindicated, children are particularly at risk, since they can contribute to weight gain. This is due to the sequestration of fluid in the lumen of the intestine, increased absorption of toxins in the large intestine. In this case, more significant lesions of the colon are noted.

Treatment of pseudomembranous colitis in children

If this is possible, then the antibacterial therapy that caused the disease should be discontinued.

Vancomycin

In children with severe toxicosis or diarrhea, the main drug is vancomycin at a dose of 10 mg / kg at 6 hours inside for 10 days.

Metronidazole

Assign inside or intravenously 10 mg / kg after 6 hours inside or intravenously. The regime has similar efficacy with vancomycin, but is significantly cheaper. The safety of this regime in children is not established, therefore in some countries it is not used.

Kolestyramine

It is not investigated for this indication in children, therefore it is not recommended.

Treatment of recurrence of infection that occurred after the course of antibiotic therapy. In 10-20% of patients, diarrhea occurs again after treatment with vancomycin or metronidazole. In some cases, this may not be a relapse of the infection, but a new infection with another strain of C. Difficile, which was found in patients with mental disorders. In these cases, the optimal treatment strategy is not defined. Usually, 7-14-day courses of metronidazole or vancomycin are administered. More prolonged use of antibiotics does not lead to eradication of C. Difficile and does not prevent relapse of the disease. Short courses of antibiotic therapy allow faster recovery of normal intestinal flora, which usually suppresses the growth of C. Difficile.

About 3% of clinically significant strains of C. Difficile can be resistant to metronidazole, resistance to vancomycin is not detected. For the treatment of mild and moderate forms of the disease, a repeated course of metronidazole is usually prescribed. In severe cases, the use of vancomycin is preferred. The tactics of treating patients with a life-threatening refractory course of infection have not been determined.

The role of colonization of the colon with the help of oral lactobacilli is not established. There are some reports of attempts to treat adult patients with capsules (1-2 capsules 3 times a day) containing about 500,000 lactobacilli each.

Another non-pathogenic biotherapeutic drug is the living Saccharomyces boulardii, which has been used since the 1950s to treat diarrhea in Europe. More recent data from the US indicate their effectiveness in the treatment of diarrhea, but more clinical experience is needed, especially with regard to diarrhea caused by C. Difficile.