The treatment of pseudomembranous colitis includes discontinuing antibiotic therapy and instituting supportive measures such as the administration of fluids and the correction of electrolyte abnormalities. Twenty-five percent of patients will respond to these measures alone. For those patients with mild to moderate disease who do not respond to supportive measures, metronidazole 250 mg four times daily is the therapy of choice. 19 Vancomycin 125 to 250 mg four times daily is an alternative regimen, although this is considerably more expensive than metronidazole. It should be reserved for cases where the patient has not responded to or is intolerant of metronidazole, where the organism is resistant to metronidazole, or where the patient is pregnant.
Severely ill persons must be hospitalized. Oral vancomycin, 125 to 250 mg four times a day for 10 days, is effective in the majority of severely ill patients. 20 The symptoms usually resolve within a few days. Rarely, emergency colectomy may be required for patients with toxic dilatation of the colon or colonic perforation.
Relapses occur in 10 to 20 percent of patients. The use of antidiarrheal agents may prolong or worsen symptoms in patients with pseudomembranous colitis and should be avoided. Steroids and surgical intervention are rarely needed.
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