Pseudomembranous Enterocolitis: Medical History

Medical history (history of illness) represents an important component in the diagnosis of pseudomembranous enterocolitis (Clostridium difficile-associated diarrhea or Clostridium difficile infection, CDI).

Family history

• What is the general health status of your family members?
• Are there any diseases in your family that are common?
• Are there any hereditary diseases in your family?

Social anamnesis

Current medical history/systemic medical history (somatic and psychological complaints).

• What symptoms have you noticed?
• Do you have diarrhea?
• How long have you had it?
• How many chairs per day?
• What does the stool look like? Watery, bloody, mucous, etc.?
• Do you have abdominal pain?
• Do you have a fever? If so, what is the temperature?

Vegetative anamnesis incl. nutritional anamnesis.

Self anamnesis incl. medication anamnesis

• Pre-existing conditions (gastrointestinal diseases, immunosuppression).
• Operations
• Radiotherapy
• Vaccination status
• Allergies

Medication history

• Antibiotics* (agents that act against bacterial infections; main risk for Clostridium difficile-associated diarrhea is in the following four weeks after antibiotic therapy; 40-60% of cases); especially:
  • High risk
    • Ampicillin
    • Aminopenicillins (amoxicillin)
    • Cephalosporins (cefoxitin, ceftazidime, ceftriaxone, cefuroxime).
    • Quinolones/fluoroquinolones/gyrase inhibitors (ciprofloxacin, moxifloxacin, nalidixic acid, norfloxacin, lomefloxacin, levofloxacin, ofloxacin).
    • Lincosamide (clindamycin)
  • Medium risk
    • Imipenem
    • Carbapenems (imipenem)
    • Tetracyclines (doxycycline, minocycline, tetracycline).
    • Trimethoprim
  • Low risk
    • Aminoglycosides (amikacin, apramycin, geneticin (G418), gentamicin, kanamycin, netilmicin, neomycin, paromomycin, spectinomycin, streptomycin, tobramycin).
    • Β-lactam antibiotic (piperacillin).
    • Broad-spectrum penicillins (mezlocillin, ticarcillin).
    • Glycopeptide antibiotics (vancomycin).
    • Macrolides (azithromycin, erythromycin, clarithromycin, especially clarithromycin and azithromacin).
• H2 antihistamines (H2 receptor antagonists, H2 antagonists, histamine H2 receptor anatgonists; agents that inhibit the production of gastric acid, among other things) – cimetidine, famotidine, lafutidine, nizatidine, ranitidine, roxatidine.
• Non-steroidal anti-inflammatory drugs (NSAID, NSAID) are painkillers with analgesic, antipyretic and anti-inflammatory properties) such as ibuprofen, diclofenac.
• Proton pump inhibitors (proton pump inhibitors, PPI; acid blockers) – esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole.

* Because Clostridium difficile is resistant to almost all broad-spectrum antibiotics, antibiotic therapy can cause this germ to multiply.