rifampin and Enterocolitis--Pseudomembranous

Can therapy with clindamycin and rifampicin be safely continued long term beyond the recommended 10-week course?. Clindamycin and rifampicin are used in combination to treat hidradenitis suppurativa (HS). There is no data on the efficacy and safety of clindamycin/rifampicin combination therapy for HS beyond 10 weeks.. We identified the following major concerns that still lack a proper evidenced-based analysis: for rifampicin, drug-induced liver injury, interstitial nephritis, drug interaction and hepatic p450 3A4 enzyme induction; for clindamycin, the concern was community-acquired Clostridium difficile infection (CA-CDI); and experience with long-term treatment. Data sources were used as appropriate to answer the question. Systematic searches were used to assess the risk of CA-CDI and experience with long-term treatment with clindamycin.. The risk for rifampicin-induced liver injury is highest in the first 6 weeks of treatment, whereas interstitial nephritis is primarily observed during intermittent treatment. Enzyme induction due to rifampicin is usually complete after about 2 weeks of treatment and reduces clindamycin blood levels by about 90%. Three meta-analyses identified antibiotic use as a risk factor for CA-CDI. Two of them assigned the highest risk to clindamycin. None of them stratified by length of treatment. There is extensive experience with rifampicin, primarily for the treatment of tuberculosis. Long-term experience with clindamycin is limited.. The analysed risks associated with a combination of clindamycin and rifampicin for hidradenitis suppurative cluster within the first 10 weeks. Treatment can be continued beyond 10 weeks, if clinically necessary.

Topics: Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Clindamycin; Cytochrome P-450 CYP3A; Cytochrome P-450 CYP3A Inducers; Drug Interactions; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Hidradenitis Suppurativa; Humans; Meta-Analysis as Topic; Nephritis, Interstitial; Rifampin; Risk Assessment; Systematic Reviews as Topic; Time Factors

Rifampin therapy is an infrequently reported cause of pseudomembranous colitis. A low index of suspicion may account for this lack of recognition. Awareness of this potentially hazardous complication of rifampin therapy is encouraged, especially since increasing numbers of patients infected with the human immunodeficiency virus, who may have diarrhea from other etiologies, require rifampin therapy.

Topics: Antibiotics, Antitubercular; Antidiarrheals; Clostridioides difficile; Diagnosis, Differential; Diarrhea; Enterocolitis, Pseudomembranous; HIV Enteropathy; Humans; Male; Metronidazole; Middle Aged; Rifampin

To date, no randomized trial to address the use of adjunctive rifampin in addition to metronidazole for the treatment of Clostridium difficile-associated diarrhea has been reported. Rifampin has excellent in vitro activity against C. difficile and penetrates into cellular materials where the organisms may persist.. This was a prospective, randomized, single-blinded study of 39 patients that compared therapy with metronidazole alone versus therapy with metronidazole and rifampin for 10 days to treat laboratory-confirmed primary episode C. difficile-associated diarrhea. Twenty patients were randomly assigned to the metronidazole group, and 19 were randomly assigned to the metronidazole and rifampin group. Data were analyzed by intention-to-treat analysis using the 2-tailed Kaplan-Meier method and the log-rank test.. Adjunctive rifampin treatment for 10 days, compared with treatment with metronidazole alone for 10 days, was associated with a similar median time to symptom improvement (9.0 days vs. 6.5 days; P=.74), a similar median time to first relapse (26 days vs. 16 days; P=.23), a similar proportion of patients with relapse by study day 40 (42% vs. 38%; P=1.0), and a similar proportion of patients experiencing nonfatal adverse events (37% vs. 40%; P=.55). There were a significantly higher number of deaths in the metronidazole and rifampin group, compared with the metronidazole group (6 of 19 patients vs. 1 of 20 patients; P=.04), but there were fewer laboratory-confirmed relapses by study day 40 (2 vs. 4; P=.66).. We conclude that there is no role for routine rifampin as an adjunct to treatment with metronidazole for hospitalized patients with C. difficile-associated diarrhea. The cure rates for both treatment groups remain unacceptably low, and better treatments are urgently needed.

Topics: Administration, Oral; Aged; Anti-Bacterial Agents; Diarrhea; Enterocolitis, Pseudomembranous; Female; Humans; Male; Metronidazole; Rifampin

Topics: Anti-Bacterial Agents; Bacteremia; Bone and Bones; Drug Administration Routes; Drug Resistance, Bacterial; Enterocolitis, Pseudomembranous; Humans; Joints; Malaria Vaccines; Plasmids; Pneumococcal Vaccines; Randomized Controlled Trials as Topic; Rifampin; Staphylococcal Infections

To determine the incidence and clinical characteristics of tuberculosis (TB) medication-associated Clostridium difficile infection.. This multicenter study included patients from eight tertiary hospitals enrolled from 2008 to 2013. A retrospective analysis was conducted to identify the clinical features of C. difficile infection in patients who received TB medication.. C. difficile infection developed in 54 of the 19,080 patients prescribed TB medication, representing a total incidence of infection of 2.83 cases per 1,000 adults. Fifty-one of the 54 patients (94.4%) were treated with rifampin. The patients were usually treated with oral metronidazole, which produced improvement in 47 of the 54 patients (87%). Twenty-three patients clinically improved with continuous rifampin therapy for C. difficile infection. There were no significant differences in improvement between patients treated continuously (n=21) and patients in whom treatment was discontinued (n=26).. The incidence of C. difficile infection after TB medication was not low considering the relatively low TB medication dosage compared to other antibiotics. It may not be always necessary to discontinue TB medication. Instead, decisions concerning discontinuation of TB medication should be based on TB status.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Antibiotics, Antitubercular; Clostridioides difficile; Enterocolitis, Pseudomembranous; Female; Humans; Incidence; Male; Metronidazole; Middle Aged; Retrospective Studies; Rifampin; Treatment Outcome; Tuberculosis

Recent surveys indicate that the majority of toxigenic Clostridium difficile strains isolated in European hospitals belonged to PCR-ribotypes (RTs) different from RT 027 or RT 078. Among these types, RT 018 has been reported in Italy and, more recently, in Korea and Japan. In Italy, strains RT 018 have become predominant in the early 2000s, whereas the majority of strains isolated before were RT 126, a type belonging to the same lineage as the RT 078. In this study, we have found that Italian strains RT 018 are resistant to erythromycin, clindamycin, moxifloxacin and rifampicin. Rifampicin resistance is rarely observed in strains RT 018 from other countries and in Italian strains RT 078 and RT 126, therefore the decennial use of rifamycin antibiotics in Italy may be one of the driving factors for the spread of RT 018 in our country. The strains RT 018 examined showed a significant higher adhesion to Caco-2 cells compared to strains RT 078 and RT 126. Furthermore, strains RT 018 became predominant in in vitro competition assays with strains RT 078 or RT 126. If maintained in vivo, these characteristics could lead to a rapid colonization of the intestine by strains RT 018. Under the conditions used, isolates RT 018 produced significantly higher toxins levels compared to strains RT 078 and RT 126, while heat-resistant CFUs production seems to be strain-dependent. Robust toxin production and enhanced sporulation could in part explain the high diffusion and interpatient transmissibility observed for strains RT 018 in the hospital environment. In conclusion, the characteristics observed in the Italian isolates RT 018 seem to contribute in conferring an adaptive advantage to these strains, allowing their successful spread in our country.

Topics: Anti-Bacterial Agents; Antibiosis; Bacterial Adhesion; Bacterial Toxins; Caco-2 Cells; Clindamycin; Clostridioides difficile; Cross Infection; Drug Resistance, Bacterial; Enterocolitis, Pseudomembranous; Erythromycin; Fluoroquinolones; Hospitals; Humans; Italy; Moxifloxacin; Ribotyping; Rifampin; Virulence

This was an in vitro study to analyse the susceptibility of Clostridium difficile isolates to rifampin and rifaximin.. Stool samples from patients who had nosocomial diarrhoea and C difficile toxin B at a university hospital between August 2006 and December 2007 were cultured for C difficile. Susceptibility of C difficile isolates to rifaximin and rifampin was determined by agar dilution and E strips, respectively. C difficile isolates were analysed via PCR for genes encoding toxins A and B, for binary toxin (BT), and for partial deletions of the tcdC gene (tcdC-del).. Rifaximin exhibited high-level activity against 359 C difficile isolates, with MIC(50) <0.01 microg/ml and MIC(90) 0.25 microg/ml; rifampin had MIC(50) <0.002 microg/ml and MIC(90) 4 microg/ml. Among isolates analysed, 55 (15%) were positive for BT and tcdC-del. 28 (8% of 359) isolates were resistant to rifampin (> or = 32 microg/ml), of which 6 (2% of 359) were resistant to rifaximin and rifampin with MIC values > or = 32 microg/ml. 2 of the 28 isolates resistant to rifampin were A(+)/B(+)/BT(+)/tcdC-del(+), 5 were A(+)/B(+)/BT(-)/tcdC-del(+), 4 were A(+)/B(+)/BT(+)/tcdC-del(-), 13 were A(+)/B(+)/BT(-)/tcdC-del(-), and 4 had no detectable toxin genes. Of the 11 isolates resistant to rifaximin alone, 1 was A(+)/B(+)/BT(-)/tcdC-del(+), 2 were A(+)/B(+)/BT(+)/tcdC-del(-), 6 were A(+)/B(+)/BT(-)/tcdC-del(-), and 2 had no detectable toxin genes.. The study demonstrates that rifaximin has high-level activity against C difficile in vitro. Determination of resistance to rifampin by E strip did not predict rifaximin resistance.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Bacterial Toxins; Clostridioides difficile; Diarrhea; Enterocolitis, Pseudomembranous; Enterotoxins; Genes, Bacterial; Hospitals, University; Humans; Microbial Sensitivity Tests; Rifampin; Rifamycins; Rifaximin; Texas

Topics: Anti-Infective Agents; Antibiotics, Antitubercular; Clostridioides difficile; Enterocolitis, Pseudomembranous; Humans; Metronidazole; Rifampin

Rifampin is used as adjunctive therapy for Clostridium difficile-associated disease, and the drug's derivative, rifaximin, has emerged as an attractive antimicrobial for treatment of C. difficile-associated disease. Rifampin resistance in C. difficile strains has been reported to be uncommon.. We examined the prevalence of rifampin resistance among 470 C. difficile isolates (51.1% during 2001-2002 and 48.9% during 2005) from a large teaching hospital. Rifampin sensitivity was performed using E-test. The epidemic BI/NAP1 C. difficile clone was identified by tcdC genotyping and multilocus variable number of tandem repeats analysis. A 200-base pair fragment of the rpoB gene was sequenced for 102 isolates. Data on rifamycin exposures were obtained for all patients.. Rifampin resistance was observed in 173 (36.8%) of 470 recovered isolates and 167 (81.5%) of 205 of epidemic clone isolates (P < .001). Six rpoB genotypes were associated with rifampin resistance. Of 8 patients exposed to rifamycins, 7 had rifampin-resistant C. difficile, compared with 166 of 462 unexposed patients (relative risk, 2.4; 95% confidence interval, 1.8-3.3).. Rifampin resistance is common among epidemic clone C. difficile isolates at our institution. Exposure to rifamycins before the development of C. difficile-associated disease was a risk factor for rifampin-resistant C. difficile infection. The use of rifaximin may be limited for treatment of C. difficile-associated disease at our institution.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Clostridioides difficile; Cluster Analysis; Cross Infection; DNA Fingerprinting; DNA-Directed RNA Polymerases; DNA, Bacterial; Drug Resistance, Bacterial; Enterocolitis, Pseudomembranous; Genotype; Hospitals, Teaching; Humans; Repressor Proteins; Rifampin; Sequence Analysis, DNA

Pseudomembranous colitis (PMC) is known to be associated with the administration of antibiotics which alter normal gastrointestinal flora and allow overgrowth of Clostridium difficile. Most cases of rifampicin-induced PMC are seen in patients with pulmonary tuberculosis, but not with gastrointestinal tuberculosis. We report a case of PMC associated with rifampicin therapy in a patient with gastrointestinal tuberculosis. A 65-year-old female patient with rectal cancer and gastrointestinal tuberculosis was admitted due to abdominal pain and diarrhea. She was treated with anti-tuberculosis agents containing rifampicin. On colonoscopic examination, mucoid exudates and yellowish plaque lesions were observed. Anti-tuberculosis agents were stopped, and the patient was treated with metronidazole. Symptoms were relieved and did not recur when all the anti-tuberculosis agents except rifampicin were started again. When a patient complains of abdominal pain or diarrhea while taking rifampicin, the physician should consider the possibility of rifampicin-associated PMC.

Topics: Aged; Antibiotics, Antitubercular; Enterocolitis, Pseudomembranous; Female; Humans; Rectal Neoplasms; Rifampin; Sigmoidoscopy; Tuberculosis, Gastrointestinal

Pseudomembranous colitis (PMC) is known to develop after antibiotic treatment, but is rarely associated with antituberculosis (anti-TB) agents. We report a 28-year-old woman without underlying diseases developing PMC after 126 days of anti-TB treatment. Severe diarrhea and abdominal cramping pain were experienced. Colonoscopic biopsy proved the diagnosis of PMC. Her symptoms improved after discontinuing the anti-TB agents but recurred shortly after challenging with rifampin and isoniazid. Metronidazole administration and replacement of rifampin with levofloxacin successfully cured the PMC. Our report supports the notion that rifampin can induce PMC.

Topics: Adult; Antitubercular Agents; Clostridioides difficile; Enterocolitis, Pseudomembranous; Female; Humans; Rifampin

Rifaximin, a poorly absorbed rifamycin derivative, is a promising alternative for the treatment of Clostridium difficile infections. Resistance to this agent has been reported, but no commercial test for rifaximin resistance exists and the molecular basis of this resistance has not been previously studied in C. difficile. To evaluate whether the rifampin Etest would be a suitable substitute for rifaximin susceptibility testing in the clinical setting, we analyzed the in vitro rifaximin susceptibilities of 80 clinical isolates from our collection by agar dilution and compared these results to rifampin susceptibility results obtained by agar dilution and Etest. We found rifaximin susceptibility data to agree with rifampin susceptibility; the MICs of both antimicrobials for all isolates were either very low or very high. Fourteen rifaximin-resistant (MIC, > or = 32 microg/ml) unique isolates from patients at diverse locations in three countries were identified. Molecular typing analysis showed that nine (64%) of these isolates belonged to the epidemic BI/NAP1/027 group that is responsible for multiple outbreaks and increased disease severity in the United Kingdom, Europe, and North America. The molecular basis of rifaximin and rifampin resistance in these isolates was investigated by sequence analysis of rpoB, which encodes the beta subunit of RNA polymerase, the target of rifamycins. Resistance-associated rpoB sequence differences that resulted in specific amino acid substitutions in an otherwise conserved region of RpoB were found in all resistant isolates. Seven different RpoB amino acid substitutions were identified in the resistant isolates, which were divided into five distinct groups by restriction endonuclease analysis typing. These results suggest that the amino acid substitutions associated with rifamycin resistance were independently derived rather than disseminated from specific rifamycin-resistant clones. We propose that rifaximin resistance in C. difficile results from mutations in RpoB and that rifampin resistance predicts rifaximin resistance for this organism.

Topics: Amino Acid Sequence; Anti-Bacterial Agents; Bacterial Proteins; Clostridioides difficile; Drug Resistance, Multiple, Bacterial; Enterocolitis, Pseudomembranous; Humans; Molecular Sequence Data; Rifampin; Rifamycins; Rifaximin; Sequence Analysis, DNA; Sequence Homology, Amino Acid

Agar dilution antimicrobial susceptibility testing (CLSI, M11-A7, 2007) performed for 208 toxin-producing clinical isolates of Clostridium difficile resulted in OPT-80 MICs ranging from 0.06 to 1 microg/ml, with 90% of the isolates inhibited by a concentration of 0.5 microg/ml. The in vitro activity of OPT-80 was independent of the susceptibilities of isolates to nine other antimicrobial agents.

Topics: Anti-Bacterial Agents; Bacterial Toxins; Clostridioides difficile; Cross Infection; Enterocolitis, Pseudomembranous; Glycosides; Humans; In Vitro Techniques; Microbial Sensitivity Tests

Pseudomembranous colitis (PMC) is known to develop after antibiotic administration, but antituberculosis agents are rarely associated with this disorder. We report 6 cases of PMC after rifampicin administration; the clinical manifestations, laboratory findings, imaging findings, and clinical course are described. The median age of patients was 68 years (range, 54 to 82 y). All patients were diagnosed with active pulmonary tuberculosis by sputum smear and culture, and 2 suffered from type 2 diabetes mellitus. The average interval between initiation of antituberculosis therapy and the onset of diarrhea was 19.8 days. The anatomic distribution of PMC included the rectum and sigmoid colon in 5 cases and up to the hepatic flexure in 1 case. All patients were cured with medical treatment, which include discontinuation of rifampicin and oral metronidazole and vancomycin. PMC recurred in 1 patient after retreatment with rifampicin. Our findings suggest that patients who are treated with antituberculosis agents, who develop acute diarrhea during or after therapy, should be evaluated for PMC.

Topics: Aged; Aged, 80 and over; Antibiotics, Antitubercular; Biopsy; Colon, Sigmoid; Colonoscopy; Enterocolitis, Pseudomembranous; Female; Humans; Male; Middle Aged; Prognosis; Rectum; Retrospective Studies; Rifampin; Severity of Illness Index; Tuberculosis, Pulmonary

Pseudomembranous colitis is a dangerous but unusual side effect of antibiotics usage. We report a case of pseudomembranous colitis that developed in a 50-year-old female patient with diabetes mellitus during first line anti-tuberculous therapy including rifampicin. The patient was diagnosed with active pulmonary tuberculosis 70 days earlier. On admission, she suffered intermittent abdominal pain and watery diarrhea for 2 weeks. Colonoscopy revealed exudative, punctuate, raised plaques with skip areas or edematous hyperemic mucosa, and histopathologic findings were consistent with pseudomembranous colitis with typical volcano-like exudate. Symptoms improved on treatment with metronidazole. There was no recurrence after reinstitution of the anti-tuberculous agents excluding rifampicin. In patients with persistent diarrhea receiving anti-tuberculosis treatment, rifampicin associated pseudomembranous colitis should always be kept in mind.

Topics: Antibiotics, Antitubercular; Enterocolitis, Pseudomembranous; Female; Humans; Middle Aged; Rifampin; Tuberculosis, Pulmonary

Pseudomembranous colitis is known to develop with long-term antibiotic administration, but antitubercular agents are rarely reported as a cause of this disease. We experienced a case of pseudomembranous colitis associated with rifampin. The patient was twice admitted to our hospital for the management of frequent bloody, mucoid, jelly-like diarrhea and lower abdominal pain that developed after antituberculosis therapy that included rifampin. Sigmoidoscopic appearance of the rectum and sigmoid colon and mucosal biopsy were compatible with pseudomembranous colitis. The antitubercular agents were discontinued and metronidazole was administered orally. The patient's symptoms were resolved within several days. The antituberculosis therapy was changed to isoniazid, ethambutol and pyrazinamide after a second bout of colitis. The patient had no further recurrence of diarrhea and abdominal pain. We report here on a case of pseudomembranous colitis associated with rifampin.

Topics: Aged; Aged, 80 and over; Antibiotics, Antitubercular; Diarrhea; Enterocolitis, Pseudomembranous; Humans; Male; Rifampin; Tuberculosis, Pulmonary

We report a case pf pseudomembranous colitis that developed in a patient with tuberculous abdominal lymphadenopathy during treatment with rifampicin. The patient had delayed presentation (3 months) after the start of rifampicin. She had one relapse after 2 months that was successfully treated, and she finished her antituberculosis therapy without any further relapses. Awareness of this serious complication of rifampicin therapy should be encountered.

Topics: Abdominal Pain; Adult; Biopsy, Needle; Colonoscopy; Dose-Response Relationship, Drug; Drug Administration Schedule; Enterocolitis, Pseudomembranous; Female; Follow-Up Studies; Humans; Immunohistochemistry; Metronidazole; Rifampin; Treatment Outcome; Tuberculosis, Lymph Node

In Sweden, mares sometimes develop acute, often fatal, colitis when their foals are treated orally with erythromycin and rifampicin for Rhodococcus (R.) equi infection. Clostridium (C.) difficile, or its cytotoxin, was demonstrated in faecal samples from 5 of 11 (45%) mares with diarrhoea. By contrast C. difficile was not found in the faecal flora of 12 healthy mares with foals treated for R. equi infection or in 56 healthy mares with healthy untreated foals. No other enteric pathogen was isolated from any diarrhoeic mare. Of 7 investigated treated foals, 4 had a high (1651.0, 1468.3, 273.0 and 88.8 microg/g) faecal concentration of erythromycin. The dams of those 4 foals developed acute colitis, whereas the dams of 3 foals with a lower (26.3, 4.6 and 3.7 microg/g) faecal erythromycin concentration remained healthy, indicating that there might have been an accidental intake of erythromycin by mares. The foals treated with antibiotics were regarded as asymptomatic carriers and potential reservoirs, as C. difficile was found in 7 of 16 foals investigated, while 56 untreated foals proved negative. The isolated C. difficile strains proved resistant to both erythromycin (MIC>256 mg/l) and rifampicin (MIC>32 mg/l), a fact that may have favoured the growth of C. difficile in the foal intestine. All mares found positive for C. difficile were, or had recently been, hospitalised together with their foals, indicating that C. difficile may be a nosocomial infection, in horses. The results emphasise that routine testing for C. difficile and its cytotoxin is recommended when acute colitis occurs in mares when their foals are treated with erythromycin and rifampicin. Preventive measures in order to avoid accidental ingestion of erythromycin by mares from the treatment of their foals are suggested.

Topics: Actinomycetales Infections; Acute Disease; Animals; Animals, Suckling; Anti-Bacterial Agents; Bacterial Proteins; Bacterial Toxins; Clostridioides difficile; Cytotoxins; Drug Resistance, Microbial; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Erythromycin; Feces; Female; Horse Diseases; Horses; Pneumonia, Bacterial; Rhodococcus equi; Rifampin

Topics: Aged; Aged, 80 and over; Antibiotics, Antitubercular; Enterocolitis, Pseudomembranous; Female; Humans; Rifampin

In Sweden there are several reports of mares developing acute colitis while their foals were being treated orally for Rhodococcus equi pneumonia with the combination of erythromycin and rifampicin. In this study 6 adult horses were given low oral dosages of these antibiotics, singly or in combination. Within 3 days post administration of erythromycin, in one case in combination with rifampicin, 2 horses developed severe colitis (one fatal). Clostridium difficile was isolated from one of the horses, whereas no specific pathogens were isolated from the other. Both horses had typical changes in blood parameters seen in acute colitis. Clostridium difficile was also isolated from the faeces of a third horse given an even lower dosage of erythromycin in combination with rifampicin. This horse developed very mild clinical symptoms and recovered spontaneously. In the fourth horse given erythromycin only, very high numbers of Clostridium perfringens were isolated. The horses given rifampicin only did not develop any clinical symptoms and there were no major changes in their faecal flora. In conclusion, it has been demonstrated that low dosages of erythromycin ethylsuccinate can induce severe colitis in horses associated with major changes of the intestinal microflora. Clostridium difficile has been demonstrated as a potential aetiological agent in antibiotic-induced acute colitis.

Topics: Actinomycetales Infections; Acute Disease; Animals; Animals, Suckling; Anti-Bacterial Agents; Clostridioides difficile; Enterocolitis, Pseudomembranous; Erythromycin Ethylsuccinate; Feces; Female; Horse Diseases; Horses; Male; Rhodococcus equi; Rifampin; Sweden

Topics: Antitubercular Agents; Enterocolitis, Pseudomembranous; Female; Humans; Middle Aged; Rifampin

An 18-year-old man developed a perforated jejunum while receiving rifampin antituberculous chemotherapy. The perforations were located within longitudinal ulcers characteristic of pseudomembranous enterocolitis. Pseudomembranous inflammation was limited to the small intestine. The absence of colonic involvement delayed establishment of the diagnosis. Successful surgical intervention consisting of small-bowel resection with primary anastomosis was accomplished for this rare and potentially fatal complication of antituberculous chemotherapy.

Topics: Adolescent; Duodenal Diseases; Enterocolitis, Pseudomembranous; Humans; Intestinal Perforation; Male; Rifampin

Topics: Colitis; Enterocolitis, Pseudomembranous; Humans; Proctocolitis; Rifampin

Topics: Clostridium; Enterocolitis, Pseudomembranous; Feces; Female; Humans; Middle Aged; Rifampin; Tuberculosis, Miliary

Topics: Adolescent; Enterocolitis, Pseudomembranous; Female; Humans; Rifampin

Topics: Colon; Enterocolitis, Pseudomembranous; Female; Humans; Middle Aged; Rifampin

Topics: Animals; Clostridium; Clostridium Infections; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Enterocolitis, Pseudomembranous; Enterotoxemia; Humans; Rifampin

Topics: Bacteria; Enterocolitis, Pseudomembranous; Humans; Intestines; Rifampin

Topics: Aged; Enterocolitis, Pseudomembranous; Female; Humans; Middle Aged; Rifampin; Tuberculosis, Pulmonary

A fifty-seven year old male with renal tuberculosis developed pseudomembranous colitis on rifampicin and ethambutol. Diarrhoea occurred within a week, and six weeks after commencing these antituberculous agents he developed typical sigmoidoscopic and biopsy findings. Withdrawal of the drugs led to rapid recovery. Repeated challenge testing indicated that the symptoms were worse when rifampicin was given, but a test dose of ethambutol also produced temporary aggravation of the diarrhoea.

Topics: Biopsy; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Ethambutol; Humans; Male; Middle Aged; Rifampin; Tuberculosis, Renal

Topics: Clostridium; Enterocolitis, Pseudomembranous; Feces; Humans; Male; Middle Aged; Rifampin