Clostridium difficile associated diarrhoea: diagnosis and treatment

doi:10.1136/bmj.331.7515.498

BMJ 2005;331:498-501 (3 September), doi:10.1136/bmj.331.7515.498

Clinical review

Clostridium difficile associated diarrhoea: diagnosis and treatment

John Starr, consultant physician

University of Edinburgh js011q1400@blueyonder.co.uk

While John Starr was working as a senior registrar at the HammersmithHospital in London, an upsurge in episodes of Clostridium difficileassociated diarrhoea seemed to be associated with increasinguse of third generation cephalosporins. This article seeks toclarify some of the diagnostic problems and help with appropriatetreatment of this condition.

The first 150 words of the full text of this article appear below.

Introduction

Clostridium difficile associated diarrhoea is a serious conditionwith a mortality of up to 25% in frail elderly people.¹ It affectsolder, frailer, hospitalised patients and also younger patientswho are immunosuppressed.

Cross infection by C difficile is common in neonatal units,but neonates do not seem to develop C difficile associated diarrhoea.

The diagnosis of C difficile associated diarrhoea depends on:

Presence of diarrhoea, defined as an increase in stool liquidityusually accompanied by an increased frequency of bowel motions.A formal cut-off is the passing of more than 300 ml of liquidstool in 24 hours
Detection of toxins produced by C difficilein the stools.

The patient may also experience abdominal pain and have systemicfeatures of malaise, fever, dehydration, and delirium. A pseudomembranouscolitis is present in severe cases. In this state there is sloughingof the colonic epithelium, which is severely inflamed due tothe . . . [Full text of this article]

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