digoxin and Enterocolitis--Pseudomembranous

Numerous medications can trigger diarrhea. In some cases it is a common side effect, and the relationship is evident (e.g. acarbose, somatostatin analogs and antibiotics). When diarrhea does occur, the therapeutic benefit of the drug should be weighed against the negative results of the side effect. If pseudomembranous colitis is suspected, prompt action is required, since a fatal outcome cannot be excluded. A particular challenge is a suspected drug association in a multimorbid patient taking several drugs, each associated with an only low diarrhea risk. In such a case, it may be necessary to discontinue drugs consecutively, or to replace a drug by another, until the diarrhea ceases, without lessening the effectiveness of the treatment.

Topics: Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Antihypertensive Agents; Antineoplastic Agents; Antirheumatic Agents; Cardiotonic Agents; Diarrhea; Digoxin; Drug-Related Side Effects and Adverse Reactions; Enterocolitis, Pseudomembranous; Female; Gastrointestinal Motility; Hormones; Humans; Hypoglycemic Agents; Male; Radiography, Abdominal; Ultrasonography

Anaerobic bacteria include the most pathogenic of microorganisms. Their primary function, however, is hardly to cause illness. They rarely are involved in epidemics or in clinically significant infections. Some organisms, e.g. lactobacilli, control the normal vaginal ecosystem, and the intestinal anaerobes probably are instrumental in restraining the growth of Clostridium difficile in human carriers. The main role of anaerobes appears to be the provision of catabolic enzymes for organic compounds that cannot be digested by enzymes of eukaryotic origin. They are needed for the catabolism of cholesterol, bile acids, and steroid hormones; they hydrolyze a number of flavonoid glycosides to anticarcinogens; and they detoxify certain carcinogens. Anaerobic enzymes are used industrially in the production of cheese; the conversion of starch to sweeteners; and the transformation of sawdust, wood chips, and waste paper to fuel. Indeed, the anaerobes may well be the gene bank on which future generations of eukaryotic organisms will rely to adapt successfully to an ever-changing world.

Topics: Animals; Bacteria, Anaerobic; Bile Acids and Salts; Biodegradation, Environmental; Biotransformation; Carrier State; Cholesterol; Digoxin; Enterocolitis, Pseudomembranous; Female; Flavonoids; Fossil Fuels; Humans; Intestinal Mucosa; Intestines; Steroids; Sweetening Agents; Vaginosis, Bacterial; Wood

Stool specimens obtained from 77 residents of a nursing home were analysed to determine the relationship between colonisation with digoxin-reducing strains of Eubacterium lentum and infection with Clostridium difficile. Patients were categorised according to previous antibiotic treatment, prescription of enteral feedings, and pattern of bowel habits. Colonisation with digoxin-reducing E. lentum was less common in subjects infected with C. difficile, in those treated with antibiotics previously, and in those prescribed enteral feedings. Normal bowel habits were more common in those without C. difficile. The lowest incidence of diarrhoea was seen in patients without C. difficile who were colonised with digoxin-reducing species. This study establishes an inverse relationship between the presence of C. difficile and E. lentum that reduce digoxin which is related to previous treatment with antibiotics and prescription of enteral feedings. Bacterial markers may prove to be a useful tool for predicting clinical disturbances in bowel function.

Topics: Adult; Aged; Aged, 80 and over; Clostridioides difficile; Diarrhea; Digoxin; Enteral Nutrition; Enterocolitis, Pseudomembranous; Eubacterium; Female; Humans; Male; Middle Aged; Nursing Homes