Hospitalized patients are colonized with C. difficile in 10 to 25 percent of cases. Broad-spectrum antibiotics—most notably clindamycin, cephalosporins, and ampicillin/amoxicillin—alter the gut flora in such a way that toxin-producing C. difficile can flourish within the colon, producing clinical manifestations of pseudomembranous colitis. It should be remembered, however, that almost any antibiotic (including metronidazole and vancomycin) can lead to pseudomembranous colitis. It should also be noted that chemotherapeutic agents15 and antiviral agents16 have been implicated as well. Most strains of C. difficile produce two toxins, toxin A, an enterotoxin, and toxin B, a cytotoxin, that interact in a complex and not completely understood manner to produce pseudomembranous colitis and its associated symptoms.
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