viewpoints IT TAKES A THIEF TO CATCH A THIEF? Treatment for antibiotic· associated colitis: another antibiotic The incrimination of CloS/ridium dijJici/e and its toxin as the direct cause of antibiotic·associated. pseudomembranous colitis has at last made possible a rational approach to treatmenL Many antibiotics are involved, including ampicillin, tetracycline and chloramphenicol, bul lincomycin and clindamycin especiaUy appear implicated, and seem to aCI predominantly by selection of resista nt C. diflicl/e strains through suppression or sensitive commensal nora. Other physiological facton; may contribute (e.g. ischaemia and age, whi ch probabl y account fo r the inci de n ce of pseudomembranous colitis in the pre· antibiotic era). Initially the only treatme nt avail able was wi thdrawal of the antibioti c but now specifi c treatment is possibl e: or al vancomycin 12S-S00mg 6- hourl y has pr oved dramatica ll y efToctive. The inciden ce of c1i ndamyci n-assoc iat ed colitis ranges from 0- 10 96 and cl ustering of cao;es in time and p laoe suggest cross-infection. Patients shoul d be nursed as for any other enteric infection. Sigmo idoscopes must be properly st eri lised. Although the publi city related to cl inda mycin may have somewhat obscured the importance of other antibioti cs, over 8096 of 174 UK notifications were associated with lincomycin/ciindamycin. The useofclindamycin should be reserved for serious infections (e.g . deep staphylococcal sepsis). 'It is an unusual paradox that an antibiotic-induc ed dis ease re s pond s so readily to treatment with a second antimicrobial drug - but oral vancomycin itself has so far proved it se lf reassuringly safe and effect ive: EdiUJf'W: British JourrW 1, ) 49 (II AU1 19 79) 2 INPHARMA 25 Aug 1979 0156-2703/79/0825-0002 $00.50/0 C ADIS Pfess

IT TAKES A THIEF TO CATCH A THIEF?

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IT TAKES A THIEF TO CATCH A THIEF?

Treatment for antibiotic·associated colitis: another antibiotic The incrimination of CloS/ridium dijJici/e and its toxin as the direct cause of antibiotic·associated. pseudomembranous colitis has at last made possible a rational approach to treatmenL Many antibiotics are involved, including ampicillin, tetracycline and chloramphenicol, bul lincomycin and clindamycin especiaUy appear implicated, and seem to aCI predominantly by selection of resistant C. diflicl/e strains through suppression or sensitive commensal nora. Other physiological facton; may contribute (e.g. ischaemia and age, which probably account fo r the incidence of pseudomembranous colitis in the pre· antibiotic era). Initially the only treatment available was withdrawal of the antibiotic but now specific treatment is possible: oral vancomycin 12S-S00mg 6-hourly has proved dramatically efToctive. The incidence of c1indamycin-associated colitis ranges from 0-10 96 and clustering of cao;es in time and plaoe suggest cross-infection. Patients should be nursed as for any other enteric infection. Sigmoidoscopes must be properly sterilised. Although the publicity related to clindamycin may have somewhat obscured the importance of other antibiotics, over 8096 of 174 UK notifications were associated with lincomycin/ciindamycin. The useofclindamycin should be reserved for serious infections (e.g. deep staphylococcal sepsis).

'It is an unusual paradox that an antibiotic-induced disease responds so readily to treatment with a second antimicrobial drug - but oral vancomycin itself has so far proved itself reassuringly safe and effect ive:

EdiUJf'W: British Medic~oJ JourrW 1, ) 49 (II AU1 1979)

2 INPHARMA 25 Aug 1979 0156-2703/79/ 0825-0002 $00.50/ 0 C ADIS Pfess