Which one of the following antibiotics is most likely to cause pseudomembranous colitis?
A. Cefaclor
B. Penicillin V
C. Erythromycin
D. Trimethoprim
E. Doxycycline
Answer:
A. Cefaclor
Discussion: Cephalosporins, not just clindamycin, are strongly linked to Clostridium difficile.
Clostridium difficile is a Gram positive rod often encountered in hospital practice. It produces an exotoxin which causes intestinal damage leading to a syndrome called pseudomembranous colitis. Clostridium difficile develops when the normal gut flora are suppressed by broad-spectrum antibiotics.
Clindamycin is historically associated with causing Clostridium difficile but the aetiology has evolved significantly over the past 10 years. Second and third generation cephalosporins are now the leading cause of Clostridium difficile.
Clinical Signs and Symptoms:
diarrhoea
abdominal pain
a raised white blood cell count is characteristic
if severe toxic megacolon may develop
Diagnosis is made by detecting Clostridium difficile toxin (CDT) in the stool
Management
first-line therapy is oral metronidazole for 10-14 days
if severe or not responding to metronidazole then oral vancomycin may be used
for life-threatening infections a combination of oral vancomycin and intravenous metronidazole should be used
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