Diagnosis, treatment, and prevention of Clostridium difficile colitis.
OBJECTIVE
To review the risk factors for, diagnosis and treatment of, and strategies for prevention of, Clostridium difficile colitis. The pharmacists' role in optimizing drug therapy is discussed.


METHODS
A Medline search was conducted to identify pertinent clinical studies, consensus guidelines, case reports, and clinical reviews published in the English language through 2002.


METHODS
Chosen studies evaluated the appropriate clinical management and prevention of Clostridium difficile colitis. Studies selected focused on pharmacists' role in the institutional management of this disease.


RESULTS
Major risk factors for developing Clostridium difficile colitis include renal failure, prolonged hospitalization, age greater than 60, and prolonged exposure to antibiotics. Outpatients are colonized with Clostridium difficile at a rate of about 3 percent while hospitalized patients may have a ten-fold higher colonization rate. Clinical presentation of C. difficile colitis includes diarrhea, abdominal cramps, fever, nausea, malaise, anorexia, and dehydration. Treatment consists primarily of oral or parenteral metronidazole for 10 to 14 days. Mandatory infection control and educational programs for both nursing and environmental services staff can greatly reduce the number of institutional infections. Pharmacists can play a key role in these programs as well as optimizing drug therapy.


CONCLUSIONS
C. difficile colitis is a hospital-acquired infection that occurs primarily in elderly debilitated patients following the prolonged use of certain antibiotics. Its incidence can be reduced through aggressive infection control procedures and staff education.
Drug Use and Disease State Management Program, University of Pittsburgh Medical Center--Presbyterian Hospital, Department of Pharmacy and Therapeutics, PA 15213-2582, USA. WardCO@msx.upmc.edu
Charles O
CO
Ward