Tuesday, 3 December 2013

Infectious colitis - Treatments in Conventional medicine

Colitis is defined as a condition of inflammation of the large intestine, including the colon, caecum and rectum.
A. In conventional medicine perspective
Infectious colitis
Clostridium difficile, atypes of infectous colitis, has become an increasingly important nosocomial pathogen and is one of the most common causes of hospital-acquired diarrhea. The incidence of C difficile infection (CDI) is increasing worldwide(97a).
A.5.1. Non surgical therapy
1. Antimotility therapy
If patients are expereince with diarrhea of small bowel origin, then Antimotility therapy can be helpful. According to the study by the Service de Médecine B Centre hospitalier universitaire de l'hôpital d'adultes, although effective therapy is not available for patients with enteric viruses, Cryptosporidium, and Microsporidium, therapy is useful for children with amebiasis, antimicrobial-associated colitis, cholera, giardiasis, various forms of Escherichia coli diarrhea and Salmonella disease, isosporiasis, shigellosis, and strongyloidiasis(98).

2. Probotic
Perturbation of bacterial microflora of the gastrointestinal (GI) tract may play an important role in the pathophysiology of some GI disorders. Probiotics have been used as a treatment modality for over a century. They may restore normal bacterial microflora and effect the functioning of the GI tract by a variety of mechanisms. According to the study by Columbia University College of Physicians and Surgeons, the efficacy of probiotics, either as a single strain or a combination of probiotics, has been tested in antibiotic-associated diarrhea, Clostridium difficile colitis, infectious diarrhea, ulcerative colitis, Crohn's disease, pouchitis, and irritable bowel syndrome, among other disorders. Results of the studies are reviewed in this article and recommendations for probiotic use in these disorders are made. Although probiotics appear to be generally safe in an outpatient setting, the situation may be different in immunocompromised, hospitalized patients who may be at a greater risk of developing probiotic sepsis(99).

3. Other treatments
In the study to review and to investigate the efficacy of antibiotic therapy for C. difficile-associated diarrhea (CDAD), conducted by Northern General Hospital, indicated that the studies provide little evidence for antibiotic treatment of severe CDAD as many studies excluded these patients. A recommendation to achieve these goals cannot be made because of the small numbers of patients in the included studies and the high risk of bias in these studies, especially related to dropouts. Most of the active comparator studies found no statistically significant difference in efficacy between vancomycin and other antibiotics including metronidazole, fusidic acid, nitazoxanide or rifaximin. Teicoplanin may be an attractive choice but for its limited availability (Teicoplanin is not available in the USA) and great cost relative to the other options. More research of antibiotic treatment and other treatment modalities of CDAD is required(100).
Other researcher indicated that treatment of Clostridium difficile CDI is challenging due to the limited number of drugs that have proven to be effective, concerns about antibiotic resistance, and recurring disease. The recent approval of fidaxomicin provides a new alternative. Immune therapy will likely play a greater role in  the future(101).

A.5.2. Surgical treatment
Sugical treatment may be necessary for patients with microscopic colitis if patients are not respond to medication treatment, depending to the patients conditions.
In the study of sixty-seven patients (mean age, 69 (range, 40-86) years; 99 percent males) were identified. All 67 patients had C. difficile verified in the colectomy specimens, found that twenty-six of 67 patients (39 percent) underwent colonoscopy; all 26 were found to have severe inflammation or pseudomembranes. Fifty-three of 67 patients (80 percent) underwent total colectomy; 14 of 67 underwent segmental colonic resection. Perforation and infarction were found in 59 of 67 patients (58 percent) at surgery. Overall mortality was 48 percent (32/67). Mean hospitalization was 36 (range, 2-297) days(102). Several recent studies have elucidated factors that contribute to the unacceptably high postoperative mortality rate: Surgical intervention too late in the course of the disease, lack of clearly defined guidelines for patient selection, and difficulty in predicting the clinical course of the disease. Perforation, need for vasopressor support, and end-organ damage all affect the postoperative mortality rate negatively(103). 
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(97) http://www.ncbi.nlm.nih.gov/pubmed/7297823
(98) http://www.ncbi.nlm.nih.gov/pubmed/2007952
(99) http://www.ncbi.nlm.nih.gov/pubmed/21180611
(100) http://www.ncbi.nlm.nih.gov/pubmed/21901692
(101) http://www.ncbi.nlm.nih.gov/pubmed/22260856
(102) http://www.ncbi.nlm.nih.gov/pubmed/15540290
(103) http://www.ncbi.nlm.nih.gov/pubmed/20583866
(104) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770507/

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