Definition: A severe condition of the colon that results in death of local tissue (necrosis), occurring as a complication of antibiotic therapy.

Causes, incidence, and risk factors: Nearly all antibiotics can cause this condition. Clostridium difficile, which occurs normally in the intestine in 10% of the population, overgrows in the presence of antibiotics. The bacteria releases a powerful toxin that is responsible for the symptoms. The lining (mucosa) of the colon becomes denuded and hemorrhagic. Risk factors are antibiotic usage and history of previous pseudomembranous colitis. The incidence is 1 out of 1,000 people.

Ampicillin is the most common antibiotic associated with this disease in children. Pseudomembranous colitis is rare in infants less than 12 months old because of the presence of protective maternal antibodies.

Prevention: People who have had an episode of pseudomembranous colitis should discuss the risk versus benefits before taking antibiotics in the future.

Symptoms: watery diarrhea, urge to defecate, abdominal cramps and low-grade fever.

Additional symptoms that may be associated with this disease: bloody stools, painful menstruation and abdominal pain.

Treatment: The antibiotic causing the condition should be stopped. Therapy with metronidazole or vancomycin may be initiated. Rehydration with oral electrolyte solutions or intravenous therapy may be indicated to replace fluids lost by diarrhea.

Expectations (prognosis): The outcome is generally good without complications.

Complications: perforation (hole) of the colon, dehydration with electrolyte imbalance and toxic megacolon.

Last updated May 25, 1999

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