PSEUDOMEMBRANOUS ENTEROCOLITIS AND ANTIBIOTICS

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Abstract
Intestinal pseudomembranous inflammation results from chemical, metabolic, and bacterial poisons acting as irritants and perhaps from other unknown factors in traumatic, surgical, and non-surgical conditions. Super-infections, often with antibiotic-resistant staphylococci, frequently result from the suppression or alteration of the normal intestinal bacterial flora and the loss of the latter''s reciprocal inhibitory effect on the former. This antibiotic-resistant bacterium commonly exists in the nasopharynx in carriers, greatest incidence occurring in communities and hospitals where antibiotics have been widely used. Staphylococcic enterotoxins act as irritants leading to intestinal membrane formation, toxemia, and a severe shock state with death occurring suddenly unless prompt, vigorous treatment is instituted. Early stool smears, cultural studies, and close observation may give early warning. Symptoms are those associated with dehydration, intestinal inflammation, paralytic ileus, and shock, often occurring as a relapse following an initial period of improvement. Medical and surgical techniques, physical condition of the patient, age, associated disorders, and amount, duration, and type of antibiotic used are factors. Treatment includes discontinuance of offending antibiotic, substitution of other effective antibiotics, correction of dehydration, restoration of blood constituents, electrolyte replacement, vasopressors, ACTH, and adrenal cortical steroids.