Colitis Associated with Variant <i>Clostridium difficile</i>
Authors: Stuart Johnson, Dale N. Gerding, Lance R. Peterson
Journal: Annals of Internal Medicine (2002)

Letters20 August 2002Colitis Associated with Variant Clostridium difficileStuart Johnson, MD, Dale N. Gerding, MD, and Lance R. Peterson, MDStuart Johnson, MDVeterans Affairs Chicago Health Care System, Lakeside Division; Chicago, IL 60611Northwestern University Medical School; Chicago, IL 60611Search for more papers by this author, Dale N. Gerding, MDVeterans Affairs Chicago Health Care System, Lakeside Division; Chicago, IL 60611Northwestern University Medical School; Chicago, IL 60611Search for more papers by this author, and Lance R. Peterson, MDVeterans Affairs Chicago Health Care System, Lakeside Division; Chicago, IL 60611Northwestern University Medical School; Chicago, IL 60611Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-137-4-200208200-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate the comments by Drs. Deming and Hyman and agree that laboratory testing should not replace clinical judgment. As we pointed out in our report, there were ample clinical clues to the diagnosis of C. difficile colitis that were ignored in light of the laboratory test results. We also agree that empirical therapy should be initiated in a seriously ill patient if the epidemiologic and clinical features are consistent with the diagnosis. Cholestyramine, however, is not recommended as a first-line therapy for C. difficile–associated diarrhea. Although there are anecdotal reports of success (1), binding resins such as ...References1. Kreutzer EW, Milligan FD. Treatment of antibiotic-associated pseudomembranous colitis with cholestyramine resin. Johns Hopkins Med J. 1978;143:67-72. [PMID: 691920] MedlineGoogle Scholar2. Mogg GA, Arabi Y, Youngs D, Johnson M, Bentley S, Burdon DW, et al. Therapeutic trials of antibiotic associated colitis. Scand J Infect Dis Suppl. 1980; :41-5. [PMID: 7010533] Google Scholar3. Taylor NS, Bartlett JG. Binding of Clostridium difficile cytotoxin and vancomycin by anion-exchange resins. J Infect Dis. 1980;141:92-7. [PMID: 7365273] CrossrefMedlineGoogle Scholar4. Gerding DN, Johnson S, Peterson LR, Mulligan ME, Silva J. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol. 1995;16:459-77. [PMID: 7594392] CrossrefMedlineGoogle Scholar5. O'Connor D, Hynes P, Cormican M, Collins E, Corbett-Feeney G, Cassidy M. Evaluation of methods for detection of toxins in specimens of feces submitted for diagnosis of Clostridium difficile-associated diarrhea. J Clin Microbiol. 2001;39:2846-9. [PMID: 11474001] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Veterans Affairs Chicago Health Care System, Lakeside Division; Chicago, IL 60611Northwestern University Medical School; Chicago, IL 60611 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoFatal Pseudomembranous Colitis Associated with a Variant Clostridium difficile Strain Not Detected by Toxin A Immunoassay Stuart Johnson , Sara A. Kent , Kevin J. O'Leary , Michelle M. Merrigan , Susan P. Sambol , Lance R. Peterson , and Dale N. Gerding Colitis Associated with Variant Clostridium difficile Quentin B. Deming and Edward S. Hyman Metrics 20 August 2002Volume 137, Issue 4Page: 298KeywordsC difficile colitisClinical trial reportingClostridium difficileColitisDiarrheaLaboratory testsPatientsResearch laboratoriesToxinsVancomycin ePublished: 20 August 2002 Issue Published: 20 August 2002 CopyrightCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...