Exotoxins produced in the large bowel by the anaerobe Clostridium difficile may result in gastrointestinal upset ranging from mild diarrhea to potentially fatal pseudo-membranous colitis. Impallomeni and colleagues studied the relationship between these infections and antibiotic use in patients in a hospital geriatric unit.
Between April 1993 and November 1994, 1,037 elderly patients were admitted to the geriatric unit. Forty-three of these patients had diarrhea with stools positive for C. difficile toxin A.
The relative risk of diarrhea was found to vary according to antibiotic therapy, with the risk ranging from 7.2 for cefotaxime and 5.2 for cefuroxime to 2.8 for erythromycin. Other antibiotics were not associated with increased risk. Patients with C. difficile diarrhea had significantly longer hospital stays than other patients in the unit. The overall mortality rate was 42 percent for patients with C. difficile diarrhea, compared with 25 percent for other patients.
The authors conclude that this sudden increase in C. difficile-related diarrhea was associated with a recommendation to use cefotaxime as a first-line agent for severe cases of community-acquired pneumonia. Although the study results demonstrate only an association and not a causal relationship, the authors recommend that cefotaxime be used in elderly patients only if no suitable alternative is available. (Impallomeni M, et al. Increased risk of diarrhoea caused by Clostridium difficile in elderly patients receiving cefotaxime. BMJ 1995,311:1345-6.)
COPYRIGHT 1996 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group
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