title: Pseudomembranous colitis associated with a triple therapy for Helicobacter pylori eradication.
abstract: Helicobacter pylori (H. pylori) is one of the most common chronic bacterial infections in humans, affecting half of world's population. Therapy for H. pylori infection has proven to be both effective and safe. The one-week triple therapy including proton pump inhibitor, clarithromycin, and amoxicillin or metronidazole is still recommended as a first-line treatment to eradicate H. pylori infection in countries with low clarithromycin resistance. Generally, this therapy is well-tolerated, with only a few and usually minor side effects. However, rare but severe adverse effects such as pseudomembranous colitis have been reported, Clostridium difficile (C. difficile) infection being the main causative factor in all cases. We report the cases of two women who developed pseudomembranous colitis after a 1-wk triple therapy consisting of pantoprazole 20 mg bid, clarithromycin 500 mg bid, and amoxicillin 1 g bid to eradicate H. pylori infection. A limited colonoscopy showed typical appearance of pseudomembranous colitis, and the stool test for C. difficile toxins was positive. Rapid resolution of symptoms and negative C. difficile toxins were obtained in both patients with oral vancomycin. No relapse occurred during a four and eleven-month, respectively, follow up. These cases suggest that physicians should have a high index of suspicion for pseudomembranous colitis when evaluate patients with diarrhea following H. pylori eradication therapy.
authors.affiliation: Anca Trifan, Irina Girleanu, Camelia Cojocariu, Catalin Sfarti, Ana Maria Singeap, Carmen Dorobat, Lucia Grigore, "Gr. T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania.
authors.forename: Anca
authors.initials: A
authors.lastname: Trifan
authors.forename: Irina
authors.initials: I
authors.lastname: Girleanu
authors.forename: Camelia
authors.initials: C
authors.lastname: Cojocariu
authors.forename: Catalin
authors.initials: C
authors.lastname: Sfarti
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Singeap
authors.forename: Carmen
authors.initials: C
authors.lastname: Dorobat
authors.forename: Lucia
authors.initials: L
authors.lastname: Grigore
authors.forename: Carol
authors.initials: C
authors.lastname: Stanciu
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D000368:Aged; D000658:Amoxicillin / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D017291:Clarithromycin / Q000009:adverse effects*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003113:Colonoscopy; D003967:Diarrhea / Q000139:chemically induced / Q000382:microbiology; D004359:Drug Therapy, Combination; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D000077402:Pantoprazole; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D014640:Vancomycin; D000658:Amoxicillin; D000077402:Pantoprazole; D017291:Clarithromycin
keywords: Clostridium difficile; Helicobacter pylori eradication; Pseudomembranous colitis; Triple therapy; Vancomycin