Diarrhoea caused by altered bowel flora due to antibiotic exposure. Severe
cases present with pseudomembranous colitis. Toxins produced by
Clostridium difficile can be demonstrated on stool samples.
The most important aspect of management is discontinuing antibiotics.
Rehydration may be necessary. This should be done with oral rehydration
solution (ORS) unless the patient is vomiting or profoundly dehydrated.
Surgery for bowel perforation.
Loperamide is contraindicated as it may result in toxic megacolon.
If diarrhoea does not settle on antibiotic withdrawal or if pseudomembranous
colitis is present:
Vancomycin, oral, 125 mg 6 hourly.
Metronidazole, oral, 800 mg 8 hourly for 10 days.
Reference and further reading
Standard Treatment Guidelines and Essential Medicines List for South Africa 2012 Edition