[Clostridium difficile associated diarrhea in cephalosporin administration: experiences of the Swiss Adverse Drug Reaction Reporting System 1981-1995].
20-25% of antibiotics-associated diarrhea cases are caused by infection with toxin-producing Clostridium difficile. Since the advent of broad-spectrum antibiotics Clostridium difficile-associated diarrhea has been observed both in ambulatory practice and as a nosocomial infection in medical and nursing institutions. Clindamycin, aminopenicillins, and cephalosporines are by far the most common triggers for this infection. We reviewed all cases of Clostridium difficile-associated diarrhea due to cephalosporines which were reported to the Swiss Drug Monitoring Center (SANZ) between 1981 and 1995. 87 cases were reported (0.9% of 9720 spontaneous reports in this period), 69 (79%) of which were considered to be due to cephalosporines. In 74% of the cases the indication for the antibiotic treatment was an upper respiratory tract infection. 61 patients received cephalosporines by oral route and 9 patients by intravenous route. Two patients had to be hospitalized. There were no deaths. The pathogenesis, clinical picture, and therapy of Clostridium difficile-associated diarrhea is discussed. We conclude from these cases in the spontaneous reporting system of SANZ that Clostridium difficile infection due to cephalosporines is a frequent occurrence. Because the course can be severe, cephalosporines should be used restrictively.
Werth
B
B
Medizinische Klinik, Kantonsspital Chur.
Kobler
E
E
Reinhart
W H
WH
Ciorciaro
C
C
Hartmann
K
K
Kuhn
M
M
D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D002511:Cephalosporins / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000139:chemically induced* / Q000453:epidemiology; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology
D002511:Cephalosporins