title: Whole-bowel irrigation as an adjunct to the treatment of chronic, relapsing Clostridium difficile colitis.
abstract: We report the successful treatment of two patients with chronic, intractable Clostridium difficile infection using whole-bowel irrigation with a polyethylene glycol solution (Golytely) as adjunctive therapy. Before this treatment, both patients had recurrent symptoms of diarrhea, weight loss, abdominal pain, and documented C. difficile toxin-positive stools despite multiple pharmacologic treatments. Each child was prescribed myriad drug therapies, including vancomycin, metronidazole, bacitracin, and rifampin. Cholestyramine and lactobacillus were also tried alone and in combination with antibiotics. In each case, symptoms recurred shortly after cessation of therapy. Whole-bowel irrigation was subsequently administered until profuse, clear liquid stools were produced. This treatment was followed by a 3-week course of oral vancomycin and lactobacillus. In both cases, the patient became asymptomatic within 3 days of therapy; they have remained symptom-free for 36 and 48 months, respectively. We suggest that whole-bowel irrigation clears active C. difficile organisms, toxins, and spores from the intestine and is effective as an adjunct to routine therapy for chronic, relapsing C. difficile infections.
authors.affiliation: Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, PA 19104, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Liacouras
authors.forename: D A
authors.initials: DA
authors.lastname: Piccoli
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D002908:Chronic Disease; D016360:Clostridioides difficile; D003131:Combined Modality Therapy; D004573:Electrolytes; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007422:Intestines; D008297:Male; D011092:Polyethylene Glycols; D012008:Recurrence; D007507:Therapeutic Irrigation
chemical_list: D000900:Anti-Bacterial Agents; D004573:Electrolytes; C033608:Golytely; D011092:Polyethylene Glycols