Diagnosis

Tests and procedures used to diagnose pseudomembranous colitis and to search for complications include:

  • Stool sample. There are a number of different stool sample tests used to detect C. difficile infection of the colon.
  • Blood tests. These may reveal an abnormally high white blood cell count (leukocytosis), which may indicate an infection like C. difficile if you also have diarrhea.
  • Colonoscopy or sigmoidoscopy. In both of these tests, your doctor uses a tube with a miniature camera at its tip to examine the inside of your colon for signs of pseudomembranous colitis — raised, yellow plaques (lesions), as well as swelling.
  • Imaging tests. If you have severe symptoms, your doctor may obtain an abdominal X-ray or an abdominal CT scan to look for complications such as toxic megacolon or colon rupture.

Treatment

Treatment strategies include:

  • Stopping the antibiotic or other medication that's thought to be causing your signs and symptoms, if possible. Sometimes, this may be enough to resolve your condition or at least ease signs, such as diarrhea.
  • Starting an antibiotic likely to be effective against C. difficile. If you still experience signs and symptoms, your doctor may use a different antibiotic to treat C. difficile. This allows the normal bacteria to grow back, restoring the healthy balance of bacteria in your colon.

    You may be given antibiotics by mouth, through a vein or through a tube inserted through the nose into the stomach (nasogastric tube). Depending on your condition, vancomycin or fidaxomicin (Dificid) is most often used. If these drugs are not available or cannot be tolerated, then metronidazole (Flagyl) may be used.

    For severe disease, your doctor may prescribe vancomycin by mouth combined with intravenous metronidazole or a vancomycin enema.

  • Having fecal microbial transplantation (FMT). If your condition is extremely severe or you have had more than one recurrence of the infection, you may be given a transplant of stool (fecal transplant) from a healthy donor to restore the balance of bacteria in your colon. The donor stool may be delivered through a nasogastric tube, inserted into the colon or placed in a capsule you swallow. Doctors may use a combination of antibiotic treatment followed by FMT.

Once you begin treatment for pseudomembranous colitis, signs and symptoms may begin to improve within a few days.

Treating recurring pseudomembranous colitis

The natural occurrence of new, more-aggressive strains of C. difficile, which are more resistant to antibiotics, has made treating pseudomembranous colitis increasingly difficult and recurrences more common. With each recurrence, your chance of having an additional recurrence increases.

Treatment options may include:

  • Repeat antibiotics. You may need a second or third round of antibiotics to resolve your condition and may need a longer duration of therapy.
  • Surgery. Surgery may be an option in people who have progressive organ failure, rupture of the colon and inflammation of the lining of the abdominal wall (peritonitis). Surgery has typically involved removing all or part of the colon (total or subtotal colectomy).

    A newer surgery that involves laparoscopically creating a loop of colon and cleaning it (loop ileostomy and colonic lavage) is less invasive and has had positive results.

  • Fecal microbial transplantation (FMT). FMT is used to treat recurrent pseudomembranous colitis. You'll receive healthy, cleaned stool in a capsule, nasogastrically or inserted into your colon.
  • Bezlotoxumab (Zinplava). The U.S. Food and Drug Administration (FDA) has approved the use of human monoclonal antibody bezlotoxumab to reduce the risk of recurrence of C. difficile infection. Used in combination with antibiotics, bezlotoxumab has been shown to significantly reduce the recurrence of infection. However, cost may be a limiting factor.

More Information

Lifestyle and home remedies

Some research suggests that concentrated supplements of good bacteria and yeasts (probiotics) can help prevent C. difficile infection, but more studies are needed for their use in treating recurrences. They are safe to use and available in capsule or liquid form without a prescription.

To cope with the diarrhea and dehydration that can occur with pseudomembranous colitis, try to:

  • Drink plenty of fluids. Water is best, but fluids with added sodium and potassium (electrolytes) also may be beneficial. Examples include sports drinks (Gatorade, Powerade, others), oral rehydration solutions (Pedialyte, Ceralyte, others), noncaffeinated soft drinks, broths and fruit juices. Avoid beverages that are high in sugar or contain alcohol or caffeine, such as coffee, tea and colas, which can aggravate your symptoms.
  • Avoid irritating foods. Stay away from spicy, fatty or fried foods, and any other foods that make your symptoms worse.

Preparing for your appointment

Your primary care doctor can usually treat pseudomembranous colitis. Based on your signs and symptoms, you may be referred to a specialist in digestive diseases (gastroenterologist). If your signs and symptoms are particularly severe, you may be told to seek emergency treatment.

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:

  • Your symptoms, including any that seem unrelated to the reason for your appointment
  • Key personal information, including major stresses, recent life changes and family medical history
  • All medications, vitamins or other supplements you take, including the doses
  • Questions to ask your doctor

Some basic questions you might want to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • What tests do I need?
  • Is my condition likely temporary or long lasting?
  • What treatments are available and which do you recommend for me?
  • I have these other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Should I see a specialist?
  • Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask additional questions. And, if possible, take a family member or friend along to help you remember the information you're given.

What to expect from your doctor

Your doctor is likely to ask you several questions, such as:

  • When did you first begin experiencing signs and symptoms?
  • Do you have diarrhea?
  • Is there blood or pus in your stools?
  • Do you have a fever?
  • Are you having abdominal pain?
  • Have your symptoms stayed the same or gotten worse?
  • During the last several weeks, have you taken antibiotics, had a surgical procedure or been hospitalized?
  • Is anyone at home sick with diarrhea, or has anyone at home been hospitalized in the last several weeks?
  • Have you ever been diagnosed with diarrhea related to C. difficile or antibiotics?
  • Do you have ulcerative colitis or Crohn's disease?
  • Are you being treated for any other medical conditions?
  • Have you traveled recently to areas with an unsafe water supply?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime

While you're waiting for your appointment, drink plenty of fluids to help prevent dehydration. Sports drinks, oral rehydration solutions (Pedialyte, Ceralyte, others), noncaffeinated soft drinks, broths and fruit juices are good options.

Dec. 09, 2020
  1. Sartelli M, et al. 2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients. World Journal of Emergency Surgery. 2019; doi:10.1186/s13017-019-0228-3.
  2. Feldman M, et al., eds. Antibiotic-associated diarrhea and Clostridioides difficile infection. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Nov. 5, 2020.
  3. Bennett JE, et al. Clostridioides difficile (formerly Clostridium difficile) infection. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Nov. 5, 2020.
  4. Ferri FF. Clostridium difficile infection. In: Ferri's Clinical Advisor 2021. Elsevier; 2021. https://www.clinicalkey.com. Accessed Nov. 5, 2020.
  5. Stuart RL, et al. ASID/ACIPC position statement — Infection control for patients with Clostridium difficile infection in healthcare facilities. Infection, Disease and Health. 2019; doi.org/10.1016/j.idh.2018.10.001.
  6. Bouza E, et al. Analysis of C. difficile infection-related outcomes in European participants in the bezlotoxumab MODIFY I and II trials. European Journal of Clinical Microbiology & Infectious Diseases. 2020; doi:10.1007/s10096-020-03935-3.
  7. Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea/all-content. Accessed Nov. 5, 2020.
  8. Picco MF (expert opinion). Mayo Clinic. Nov. 22, 2020.

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