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Treatments and drugs
By Mayo Clinic staffOnce the diagnosis of pseudomembranous colitis is made, your doctor will stop the antibiotic that was associated with development of the disorder. Sometimes, this may be enough to resolve your condition, or at least ease signs, such as diarrhea.
If you have severe symptoms and your doctor suspects pseudomembranous colitis, you may be started on treatment before stool tests confirm the diagnosis. Once you begin treatment for pseudomembranous colitis, signs and symptoms may begin to improve within a few days, and they often resolve completely within two weeks.
To treat more-severe cases of pseudomembranous colitis, your doctor will choose from among a number of medications, particularly antibiotics other than the one associated with your illness.
Most common medications
The antibiotic metronidazole (Flagyl) is the first drug of choice for treating disorders associated with C. difficile bacteria. However, recent research suggests that the antibiotic vancomycin (Vancocin) may produce a faster response and may be associated with a lower risk of recurrence. If your condition is severe, your doctor may prescribe vancomycin first because of its rapid response rate. However, vancomycin only works when it's given as a pill. If you are very ill and not eating, your doctor may prescribe intravenous metronidazole.
If you're a pregnant woman in your first trimester, don't take metronidazole because of the risk of birth defects. It's also a poor choice if you're breast-feeding because the drug's effect on babies is unknown. Doctors also generally avoid prescribing this medication in children younger than 10 years old. In certain cases, doctors may give a combination of vancomycin and metronidazole.
Rifaximin (Xifaxan) is another antibiotic that doctors sometimes use to manage pseudomembranous colitis.
The antibiotics used to treat pseudomembranous colitis are usually given by mouth. However, depending on the severity of the inflammation and the medication, you may be treated with these drugs intravenously, via an enema, or through a tube inserted through your nose and threaded into your stomach (nasogastric tube).
Recurrent inflammation
Even in people who are treated successfully, pseudomembranous colitis may recur in up to 20 percent of cases within weeks to months after treatment has been completed. You may need a second or third round of drug therapy to resolve your condition.
If your infection comes back, your doctor may treat you again with metronidazole. If it comes back still again, you may receive a prolonged course of vancomycin to get rid of the infection.
Your doctor may also give you a yeast called Saccharomyces boulardii (Florastor) or another probiotic to help restore your colon's normal bacteria. Probiotics are dietary supplements or foods that contain beneficial bacteria normally found in your intestinal tract. Small studies have suggested that probiotics may shorten the duration of diarrhea related to antibiotic use and may prevent a relapse of C. difficile infection, but more research is needed.
Why antibiotics as a treatment?
Antibiotics cause pseudomembranous colitis because they kill the normal bacteria in your colon and allow toxic C. difficile to grow. Although it may seem strange to use antibiotics to treat a disorder caused by antibiotics, treatment with antibiotics eradicates the C. difficile and allows the normal bacteria to grow back, restoring the balance of bacteria in your colon to what it was before any antibiotics were given.
Dealing with dehydration
If you become dehydrated due to diarrhea, your doctor will prescribe electrolyte solutions to replace lost fluids. At times, these rehydration solutions will be administered intravenously.
Don't take anti-diarrheal medications — such as loperamide (Imodium) or the combination drug diphenoxylate and atropine (Lomotil) — without your doctor's knowledge. These drugs could worsen the signs and symptoms of pseudomembranous colitis.
When surgery is an option
If antibiotic treatment doesn't reduce colonic inflammation and ease your symptoms, and your condition worsens, your doctor may recommend intestinal surgery. This is rare, however; surgery is needed in less than 4 percent of people with pseudomembranous colitis.
Surgery becomes an option in people who have progressive organ failure, rupture of the colon and inflammation of the lining of the abdominal wall (peritonitis). Surgery typically involves removal (resection) of the diseased section of the bowel (subtotal colectomy).
