Advertisement

Antibiotikaassoziierte Diarrhö und pseudomembranöse Kolitis

  • J. Stein
  • O. Schröder

Zusammenfassung

Die antibiotikaassoziierte Diarrhö bezeichnet eine akute entzündliche Darmstörung, die bei und nach Anwendung von Antibiotika auftritt. Das klinische Spektrum reicht von einer passageren leichten Erhöhung der Stuhlfrequenz bis hin zur pseudomembranösen Kolitis, dem Auftreten eines toxischen Megakolons bis zu letalen Ausgängen (Bartlett 2002).

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Aboudola S, Kotloff KL, Kyne L et al. (2003) Clostridium difficile vaccine and serum immunoglobulin G antibody response to toxin A. Infect Immun 71: 1608–1610PubMedCrossRefGoogle Scholar
  2. Apisarnthanarak A, Razavi B, Mundy LM (2002) Adjunctive intracolonic vancomycin for severe Clostridium difficile colitis: case series and review of the literature. Clin Infect Dis 35: 690–696PubMedCrossRefGoogle Scholar
  3. Ariano RE, Zhanel GG, Harding GK (1990) The role of anion-exchange resins in the treatment of antibiotic-associated pseudomembranous colitis. CMAJ 142: 1049–1051PubMedGoogle Scholar
  4. Aslam S, Hamill RJ, Musher D (2005) Treatment of Clostridium difficile-asociated disease: old therapies and new strategies. Lancet Infect Dis 5: 549–557PubMedCrossRefGoogle Scholar
  5. Barbut F, Richard A, Hamadi K, Chomette V Burghoffer B, Petit JC (2000) Epidemiology of recurrences or reinfections of Clostridium difficile-associated diarrhea. J Clin Microbiol 38: 2386–2388PubMedGoogle Scholar
  6. Bartlett JG (2002) Clinical practice. Antibiotic-associated diarrhea. N Engl J Med 346: 334–339PubMedCrossRefGoogle Scholar
  7. Beales IL (2002) Intravenous immunoglobulin for recurrent Clostridium difficile diarrhoea. Gut 51: 456PubMedCrossRefGoogle Scholar
  8. Bellaiche G, Le Pennec MP, Choudat L (1997) Value of rectosigmoidoscopy with bacterial culture of colonic biopsies in the diagnosis of post-antibiotic hemorrhagic colitis related to Klebsiella oxycota. Gastroenterol Clin Biol 21: 910–915Google Scholar
  9. Beloosesky Y, Grosman B, Marmelstein V, Grinblat J (2000) Convulsions induced by metronidazole treatment for Clostridium difficile-associated disease in chronic renal failure. Am J Med Sci 319: 338–339PubMedCrossRefGoogle Scholar
  10. Bergogne-Bérézin E (2004) Treatment and prevention of antibiotic-associated colitis. In: Guglietta A (ed) Pharmacotherapy of Gastrointestinal Inflammatio. Birkhäuser, Basel Boston Berlin, pp 77–92Google Scholar
  11. Berrington A, Brriello P, Brazier J et al. (2004) National Clostridium difficile Standards Group: report to the department of health. J Hosp Infect 56(Suppl. 1): 1–38Google Scholar
  12. Beugerie L, Metz M, Barbut F et al. (2003) Klebsiella oxytoca as an agent of antibiotic-associated hemorrhagic colitis. Clin Gastroenterol Hepatol 1: 370–376CrossRefGoogle Scholar
  13. Bleichner G, Blehaut H, Mentec H, Moyse D (1997) Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients. A multicenter, randomized, double-blind placebo-controlled trial. Intensive Care Med 23: 517–523PubMedCrossRefGoogle Scholar
  14. Bliss DZ, Johnson S, Savik K et al. (1998) Acquisition of Clostridium difficile and Clostridium difficile-associated diarrhea in hospitalized patients receiving tube feeding. Ann Intern Med 129: 1012–1019PubMedGoogle Scholar
  15. Bolton RP, Culshaw MA (1986) Faecal metronidazole concentrations during oral and intravenous therapy for antibiotic associated colitis due to Clostridium difficile. Gut 27: 1169–1172PubMedGoogle Scholar
  16. Borriello SP, Hammes WP, Holzapfel W et al. (2003) Safety of probiotics that contain lactobacilli or bifidobacteria. Clin Infect Dis 36: 775–780PubMedCrossRefGoogle Scholar
  17. Bricker E, Garg R, Nelson R et al. (2005) Antibiotic treatment for Clostridium difficile-associated diarrhea in adults. Cochrane Database Syst Rev 25: CD004610Google Scholar
  18. Brown E, Talbot GH, Axelrod P, Provencher M, Hoegg C (1990) Risk factors for Clostridium difficile toxin-associated diarrhea. Infect. Control Hosp Epidemiol 11: 283–290PubMedCrossRefGoogle Scholar
  19. Buggy BP, Fekety R, Silva J jr (1987) Therapy of relapsing Clostridium difficile-associated diarrhea and colitis with the combination of vancomycin and rifampin. J Clin Gastroenterol 9: 155–159PubMedGoogle Scholar
  20. Caron F, Ducrotte P, Lerebours E et al. (1991) Effects of amoxicillin-clavulate combination on the motility of the small intestine in human beings. Antimicrob Agents Chemother 35: 1085–1088PubMedGoogle Scholar
  21. Clausen MR, Bonnen H, Tvede M et al. (1991) Colonic fermentation to short-chain fatty acids is decreased in antibiotic-associated diarrhea. Gastroenterology 101: 411–417Google Scholar
  22. Climo MW, Israel DS, Wong ES et al. (1998) Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost. Ann Intern Med 128: 989–995PubMedGoogle Scholar
  23. Cremonini F, Di Caro S, Nista EC et al. (2002) Meta-analysis: the effect of probiotic administration on antibiotic-associated diarrhoea. Aliment Pharmacol Ther 16: 1461–1467PubMedCrossRefGoogle Scholar
  24. Cunningham R, Dale B, Undy B, Gaunt N (2003) Proton pump inhibitors as a risk factor for Clostridium difficile diarrhoea. J Hosp Infect 54: 243–245PubMedCrossRefGoogle Scholar
  25. de Lalla F, Nicolin R, Rinaldi E et al. (1992) Prospective study of oral teicoplanin versus vancomycin for therapy of pseudomembraneous colitis and Clostridium difficile-associated diarrhea. Antimicrob Agents Chemother 36: 2192–2196PubMedGoogle Scholar
  26. Delmée M, Vandercam B, Avesani V, Michaux JL (1987) Epidemiology and prevention of Clostridium difficile infections in a leukemia unit. Eur J Clin Microbiol 6: 623–627PubMedCrossRefGoogle Scholar
  27. Delmée M, Van Broeck J, Simon A, Janssens M, Avesani V (2005) Laboratory diagnosis of Clostridium difficile-associated diarrhoea: a plea for culture. J Med Microbiol 54: 187–191PubMedCrossRefGoogle Scholar
  28. Dietrich CF, Lembcke B, Seifert H et al. (2000) Sonographische Diagnostik der Penicillin-induzierten segmentär-hämorrhagischen Colitis. Dtsch Med Wschr 125: 755–760PubMedCrossRefGoogle Scholar
  29. Dobbins WO 3rd, Herrero BA, Mansbach CM (1968) Morphologic alterations associated with neomycin induced malabsorption. Am J Med Sci 255: 63–77PubMedCrossRefGoogle Scholar
  30. Donskey CJ (2004) The role of the intestinal tract as a reservoir and source for transmission of nosocomial pathogens. Clin Infect Dis 39: 219–226PubMedCrossRefGoogle Scholar
  31. D’Souza AL, Rajkumar C, Cooke J, Bulpitt CJ (2002) Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis. BMJ 324: 1361PubMedCrossRefGoogle Scholar
  32. Dudley MN, McLaughlin JC, Carrington G, Nightingale CH, Quintiliani R (1986) Oral bacitracin vs vancomycin therapy for Clostridium difficile-associated diarrhea. A randomized double-blind trial. Arch Intern Med 146: 1101–1104PubMedCrossRefGoogle Scholar
  33. Fekety R (1997) Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 92: 739–750PubMedGoogle Scholar
  34. Fekety R, Silva J, Kauffman C et al. (1989) Treatment of antibiotic-associated Clostridium difficile colitis with oral vancomycin: comparison of two dosage regimens. Am J Med 86: 15–19PubMedCrossRefGoogle Scholar
  35. Fernandez A, Anand G, Friedenberg F (2004) Factors associated with failure of metronidazole in Clostridium difficile-associated disease. J Clin Gastroenterol 38: 414–418PubMedGoogle Scholar
  36. Friedenberg F, Fernandez A, Kaul V et al. (2001) Intravenous metronidazole for the treatment of Clostridium difficile colitis. Dis Colon Rectum 44: 1176–1180PubMedCrossRefGoogle Scholar
  37. Fuhrman MP (1999) Diarrhea and tube feeding: The treatment of diarrhea in tube-fed patients. Nutr Clin Pract 14: 84–87CrossRefGoogle Scholar
  38. Garbutt JM, Littenberg B, Evanoff BA et al. (1999) Enteric carriage of vancomycin-resistant Enterococcus faecium in patients tested for Clostridium difficile. Infect Control Hosp Epidemiol 20: 664–670PubMedCrossRefGoogle Scholar
  39. Gerding DN (2000) Treatment of Clostridium difficile-associated diarrhea and colitis. Curr Top Microbiol Immunol 250: 127–139PubMedGoogle Scholar
  40. Gerding DN, Johnson S, Peterson LR et al. (1995) Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 16: 459–477PubMedGoogle Scholar
  41. Goldhill JM, Rose K, Percy WH (1996) Effects of antibiotics on epithelial ion transport in the rabbit distal colon in-vitro. J Pharm Pharmacol 39: 555–558Google Scholar
  42. Gorbach SL, Chang TW, Goldin B (1987) Successful treatment of relapsing Clostridium difficile colitis with Lactobacillus GG. Lancet 2: 1519PubMedCrossRefGoogle Scholar
  43. Guerrant RL, Van Gilder T, Steiner TS et al. (2001) Practice guidelines for the management of infectious diarrhea. Clin Infect Dis 32: 331–351PubMedCrossRefGoogle Scholar
  44. Heer M, Sulser H, Hany A (1989) Segmental hemorrhagic colitis following amoxicillin therapy. Schweiz Med Wochenschr 119: 733–735PubMedGoogle Scholar
  45. Heerze LD, Kelm MA, Talbot JA, Armstrong GD (1994) Oligosaccharide sequences attached to an inert support (SYNSORB) as potential therapy for antibiotic-associated diarrhea and pseudomembranous colitis. J Infect Dis 169: 1291–1296PubMedGoogle Scholar
  46. Higaki M, Chida T, Takano H et al. (1990) Cytotoxic component(s) of Klebsiella oxytoca on HeEp-2 cells. Microbiol Immunol. 21: 764–767Google Scholar
  47. Hofmann AF (1977) Bile acids, diarrhea, and antibiotics: data, speculation, and a unifying hypothesis. J Infect Dis 135(Suppl.): S126–S132PubMedGoogle Scholar
  48. Jarvis WR (1998) Epidemiology, appropriateness, and cost of vancomycin use. Clin Infect Dis 26: 1200–1203PubMedGoogle Scholar
  49. Johnson S, Gerding DN (1998) Clostridium difficile-associated diarrhea. Clin Infect Dis 26: 1027–1036PubMedGoogle Scholar
  50. Johnson S, Homann SR, Bettin KM et al. (1992) Treatment of asymptomatic Clostridium difficile carriers (fecal excretors) with vancomycin or metronidazole. A randomized, placebo-controlled trial. Ann Intern Med 117: 297–302PubMedGoogle Scholar
  51. Johnson S, Samore MH, Farrow KA et al. (1999) Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals. N Engl J Med. 341: 1645–1651PubMedCrossRefGoogle Scholar
  52. Johnson S, Sanchez JL, Gerding DN (2000) Metronidazole resistance in Clostridium difficile. Clin Infect Dis 31: 625–626PubMedCrossRefGoogle Scholar
  53. Just I, Gerhard R (2004) Large clostridial cytotoxins. Rev Physiol Biochem Pharmacol 152: 23–47PubMedCrossRefGoogle Scholar
  54. Karlstrom O, Fryklund B, Tullus K et al. (1998) Swedish C. difficile study group: A prospective nationwide study of Clostridium difficile-associated diarrhea in Sweden. Clin Infect Dis 26: 141–145PubMedGoogle Scholar
  55. Kerr RB, McLaughlin DI, Sonnenberg LW (1990) Control of Clostridium difficile colitis outbreak by treating asymptomatic carriers with metronidazole. Am J Infect Control 18: 332–335PubMedCrossRefGoogle Scholar
  56. Khan R, Cheesbrough J (2003) Impact of changes in antibiotic policy on Clostridium difficile-associated diarrhoea (CDAD) over a five-year period in a district general hospital. J Hosp Infect 54: 104–108PubMedCrossRefGoogle Scholar
  57. Kotowska M, Albrecht P, Szajewska H (2005) Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea in children: a randomized double-blind placebo-controlled trial. Aliment Pharmacol Ther 21: 583–590PubMedCrossRefGoogle Scholar
  58. Krause R, Reisinger EC (2005) Candida and antibiotic-associated diarrhoea. Clin Microbiol Infect 11: 1–2PubMedCrossRefGoogle Scholar
  59. Krause R, Schwab E, Bachhiesl D et al. (2001) Role of Candida in antibiotic-associated diarrhea. Infect Dis 184: 1065–1069CrossRefGoogle Scholar
  60. Kyne L, Warny M, Qamar A, Kelly CP (2001) Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet 357: 189–193PubMedCrossRefGoogle Scholar
  61. Leung DY, Kelly CP, Boguniewicz M et al. (1991) Treatment with intravenously administered gamma globulin of chronic relapsing colitis induced by Clostridium difficile toxin. J Pediatr 118: 633–637PubMedCrossRefGoogle Scholar
  62. Lewis S, Burmeister S, Brazier J (2005) Effect of the Prebiotic Oligofructose on Relapse of Clostridium difficile-Associated Diarrhea: A Randomized, Controlled Study. Clin Gastroenterol Hepatol 3: 442–448PubMedCrossRefGoogle Scholar
  63. Ludlam H, Brown N, Sule O, Redpath et al. (1999) An antibiotic policy associated with reduced risk of Clostridium difficile-associated diarrhea. Age Aging 28: 578–580CrossRefGoogle Scholar
  64. Massey V, Gregson DB, Chagla AH et al. (2003) Clinical usefulness of components of the Triage immunoassay, enzyme immunoassay for toxins A and B, and cytotoxin B tissue culture assay for the diagnosis of Clostridium difficile diarrhea. Am J Clin Pathol 119: 45–49PubMedCrossRefGoogle Scholar
  65. Mayfield JL, Leet T, Miller J, Mundy LM (2000) Environmental control to reduce transmission of Clostridium difficile. Clin Infect Dis 31: 995–1000PubMedCrossRefGoogle Scholar
  66. McFarland LV (2005) Alternative treatments for Clostridium difficile disease: what really works? J Med Microbiol 54: 101–111PubMedCrossRefGoogle Scholar
  67. McFarland LV, Mulligan ME, Kwok RY, Stamm WE (1989) Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 320: 204–210PubMedCrossRefGoogle Scholar
  68. McFarland LV, Surawicz CM, Greenberg RN et al. (1994) A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA 271: 1913–1918PubMedCrossRefGoogle Scholar
  69. McFarland LV, Elmer GW, Surawicz CM (2002) Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol 97: 1769–1775PubMedCrossRefGoogle Scholar
  70. McNulty C, Logan M, Donald IP et al. (1997) Successful control of Clostridium difficile infection in an elderly care unit through use of a restrictive antibiotic policy. J Antimicrob Chemother 40: 707–711PubMedCrossRefGoogle Scholar
  71. Minami J, Saito S, Yoshida T et al. (1992) Biological activities and chemical composition of a cytotoxin of Klebsiella oxytoca. J Gen Microbiol 138: 1921–1927PubMedGoogle Scholar
  72. Moulis H, Vender RJ (1994) Antibiotic-associated hemorrhagic colitis. J Clin Gastroenterol 18: 227–231PubMedGoogle Scholar
  73. Mrowka C, Munch R, Rezzonico M Greminger P (1990) Acute segmental hemorrhagic penicillin-associated colitis. Dtsch Med Wochenschr 115: 1750–1753PubMedCrossRefGoogle Scholar
  74. Nomura K, Matsumoto Y, Yoshida N et al. (2004) Successful treatment with rifampin for fulminant antibiotics-associated colitis in a patient with non-Hodgkin’s lymphoma. World J Gastroenterol 10: 765–766PubMedGoogle Scholar
  75. Pear SM, Williamson TH, Bettin KM et al. (1994) Decrease in nosocomial Clostridium difficile-associated diarrhea by restricting clindamycin use. Ann Intern Med 120: 272–277PubMedGoogle Scholar
  76. Pelaez T, Alcacia L, Alonso R et al. (2002) Reassessment of Clostridium difficile susceptibility to metronidazole and vancomycin. Antimicrob Agents Chemother 28: 1647–1650CrossRefGoogle Scholar
  77. Pépin J, Valiquette L, Alary ME et al. (2004) Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003. A changing pattern of disease severity CMAJ 17: 466–472Google Scholar
  78. Pépin J, Alary ME, Valiquette L et al. (2005a) Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis 40: 1591–1579PubMedCrossRefGoogle Scholar
  79. Pépin, J, Saleh N, Coulombe MA et al. (2005b) Emergence of fluoroquinolones as the predominat risk factor for clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 40: 1254–1260CrossRefGoogle Scholar
  80. Persky SE, Brandt LJ (2000) Treatment of recurrent Clostridium difficile-associated diarrhea by administration of donated stool directly through a colonoscope. Am J Gastroenterol 95: 3283–3285PubMedGoogle Scholar
  81. Pochapin M (2000) The effect of probiotics on Clostridium difficile diarrhea. Am J Gastroenterol 95: S11–S13PubMedCrossRefGoogle Scholar
  82. Poutanen SM, Simor AE (2004) Clostridium difficile-associated diarrhea in adults. CMAJ 171: 51–58PubMedGoogle Scholar
  83. Rao SS, Edwards CA, Austen CJ et al. (1988) Impaired colonic fermentation of carbohydrate after ampicillin. Gastroenterology 94: 928–932PubMedGoogle Scholar
  84. Riley TV (2004) Nosocomial diarrhea due to Clostridium difficile. Curr Opin Infect Dis 17: 323–327PubMedCrossRefGoogle Scholar
  85. Rupnik M, Dupuy B, Fairweather NF et al. (2005) Revised nomenclature of Clostridium difficile toxins and associated genes. J Med Microbiol 54: 113–117PubMedCrossRefGoogle Scholar
  86. Sakurai Y, Tsuchiya H, Ikegami F et al. (1979) Acute right-sided hemorrhagic colitis associated with oral administration of ampicillin. Dig Dis Sci 24: 910–915PubMedCrossRefGoogle Scholar
  87. Salcedo J, Keates S, Pothoulakis C et al. (1997) Intravenous immunoglobulin therapy for severe Clostridium difficile colitis. Gut 41: 366–370PubMedCrossRefGoogle Scholar
  88. Shim JK, Johnson S, Samore MH et al. (1998) Primary symptomless colonization by Clostridium difficile and decreased risk of subsequent diarrhea. Lancet 351: 633–636PubMedCrossRefGoogle Scholar
  89. Sougioultzis S, Kyne L, Drudy D et al. (2005) Clostridium difficile toxoid vaccine in recurrent C. difficile-associated diarrhea. Gastroenterology 128: 764–770PubMedCrossRefGoogle Scholar
  90. Surawicz CM, McFarland LV, Elmer G, Chinn J (1989) Treatment of recurrent Clostridium difficile colitis with vancomycin and Saccharomyces boulardii. Am J Gastroenterol 84: 1285–1287PubMedGoogle Scholar
  91. Surawicz CM, McFarland LV, Greenberg RN et al. (2000) The search for a better treatment for recurrent Clostridium difficile disease: use of high-dose vancomycin combined with Saccharomyces boulardii. Clin Infect Dis 31: 1012–1017PubMedCrossRefGoogle Scholar
  92. Szajewska H, Mrukowicz J (2005) Meta-analysis: non-pathogenic yeast Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Aliment Pharmacol Ther 22: 365–372PubMedCrossRefGoogle Scholar
  93. Takamine F, Imanura T (1995) Isolation and characterization of bile acid 7-dehydroxylating bacteria from human feces. Microbiol Immunol 39: 11–18PubMedGoogle Scholar
  94. Teasley DG, Gerding DN, Olson MM et al. (1983) Prospective randomized trial of metronidazole versus vancomycin for Clostridium difficille-associated diarrhea and colitis. Lancet 2: 1043–1046PubMedCrossRefGoogle Scholar
  95. Thomas C, Stevenson M, Williamson DJ, Riley TV (2002) Clostridium difficile-associated diarrhea: epidemiological data from Western Australia associated with a modified antibiotic policy. Clin Infect Dis 35: 1457–1462PubMedCrossRefGoogle Scholar
  96. Thomas C, Stevenson M, Riley TV (2003) Antibiotics and hospitalacquired Clostridium difficile-associated diarrhoea: a systematic review. J Antimicrob Chemother 51: 1339–1350PubMedCrossRefGoogle Scholar
  97. Turgeon DK, Novicki TJ, Quick J et al. (2003) Six rapid tests for direct detection of Clostridium difficile and its toxins in fecal samples compared with the fibroblast cytotoxicity assay. J Clin Microbiol 1: 667–670CrossRefGoogle Scholar
  98. van Dissel JT, de Groot N, Hensgens CM et al. (2005) Bovine antibody-enriched whey to aid in the prevention of a relapse of Clostridium difficile-associated diarrhoea: preclinical and preliminary clinical data. J Med Microbiol 54: 197–205PubMedCrossRefGoogle Scholar
  99. Voth DE, Ballard JD (2005) Clostridium difficile Toxins: Mechanism of action and role in disease. Clin Microbiol Rev 18: 247–263PubMedCrossRefGoogle Scholar
  100. Wenisch C, Parschalk B, Hasenhundl M et al. (1996) Comparison of vancomycin, teicoplanin, metronidazole, and fusidic acid for the treatment of Clostridium difficile-associated diarrhea. Clin Infect Dis 22: 813–818PubMedGoogle Scholar
  101. Wilcox MH (2003) Gastrointestinal disorders and the critically ill. Clostridium difficile infection and pseudomembranous colitis. Best Pract Res Clin Gastroenterol 17: 475–493PubMedCrossRefGoogle Scholar
  102. Wilcox MH (2004) Descriptive study of intravenous immunoglobulin for the treatment of recurrent Clostridium difficile diarrhoea. J Antimicrob Chemother 53: 882–884PubMedCrossRefGoogle Scholar
  103. Wilcox MH, Fawley WN, Settle CD, Davidson A (1998) Recurrence of symptoms in Clostridium difficile infection—relapse or reinfection? J Hosp Infect 38: 93–100PubMedCrossRefGoogle Scholar
  104. Wilkins TD, Lyerly DM (2003) Clostridium difficile testing: after 20 years, still challenging. J Clin Microbiol 41: 531–534PubMedCrossRefGoogle Scholar
  105. Wistrom J, Norrby SR, Myhre EB et al. (2001) Frequency of antibiotic-associated diarrhoea in 2462 antibiotic-treated hospitalized patients: a prospective study. J Antimicrob Chemother 47: 43–50PubMedCrossRefGoogle Scholar
  106. Wullt M, Odenholt I (2004) A double-blind randomized controlled trial of fusidic acid and metronidazole for treatment of an initial episode of Clostridium difficile-associated diarrhoea. J Antimicrob Chemother 54: 211–216PubMedCrossRefGoogle Scholar
  107. Wullt M, Hagslatt ML, Odenholt I (2003) Lactobacillus plantarum 299v for the treatment of recurrent Clostridium difficile-associated diarrhoea: a double-blind, placebo-controlled trial. Scand J Infect Dis 35: 365–367PubMedCrossRefGoogle Scholar
  108. Young VB, Schmidt TM (2004) Antibiotic-associated diarrhea accompanied by large-scale alterations in the composition of the fecal microbiota. J Clin Microbiol 42: 1203–1206PubMedCrossRefGoogle Scholar
  109. Young GP, Ward PB, Bayley N et al. (1985) Antibiotic-associated colitis due to Clostridium difficile: Double-blind comparison of vancomycin with bacitracin. Gastroenterology 89: 1038–1045PubMedGoogle Scholar
  110. Zafar AB, Gaydos LA, Furlong WB et al. (1998) Effectiveness of infection control program in controlling nosocomial Clostridium difficile. Am J Infect Control 26: 588–593PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag Heidelberg 2006

Authors and Affiliations

  • J. Stein
    • 1
  • O. Schröder
    • 1
  1. 1.Medizinische Klinik I, Klinikum der Johann WolfgangGoethe-UniversitätFrankfurt am Main

Personalised recommendations