Management of Antibiotic Associated Colitis

Any patient who develops diarrhoea on the ward should be barrier nursed and contact should be made with the infection control nurse.

• Antibiotic associated colitis should be suspected in any patient who is receiving or who has received a course of antibiotics in the last 6 to 8 weeks and complains of watery diarrhoea with or without;

  - low grade fever
  - abdominal tenderness
  - leucocytosis
  - abdominal pain ) These are rare
  - frank blood in stools )

  (Cl. difficile diarrhoea may occur in patients who have no history of antibiotic exposure).

Management

1. Treat only if the patient is symptomatic

2. Barrier nurse the patient and contact the Infection Control Nurse.

3. For symptomatic disease, start metronidazole 400mg tds and continue for 10 days. If symptoms mild await toxin result before starting treatment.

4. Send a stool sample for clostridium difficile toxin assay. Consider sigmoidoscopy.

5. If the patient is still on antibiotics, consider whether these need to be continued;

   - if no then discontinue the antibiotics
   - if yes then consult Microbiology or Pharmacy for suitable alternatives

6. Clinically mild disease: await toxin result. If positive start metronidazole 400mg 8 hourly orally and continue for 10 days.

7. Clinically severe disease: start treatment while awaiting toxin result : metronidazole 400mg 8 hourly.

   • For patients who are nil by mouth, use metronidazole 500mg intravenously every 8 hours.

   • Vancomycin (125mg 6 hourly orally) should only be used in patients hypersensitive to metronidazole, or on the advice of a microbiologist  following two courses of metronidazole. Higher doses have not been  demonstrated to be more effective.

Toxin Result

Microbiology will telephone all positive toxin results within 48 hours of receipt of the sample in the laboratory (Sundays and Bank holidays may be an exception).

• Positive: continue oral metronidazole for 10 days. There is no need to document clearance from stools if the patient has responded to treatment.

• Persistent or recurrent disease: management should be discussed with a medical microbiologist.