Therapy

If pseudomembranous colitis is related to antibiotic therapy, it should be discontinued immediately. In some cases this is already sufficient. The natural intestinal flora can develop again after stopping the therapy and curbs the spread of Clostridium difficile.

In severe cases, a fluid and electrolyte supply is usually essential. This often has to be done parenterally via the vein, as patients cannot absorb fluid due to the massive diarrhea. Medicines against diarrhoea should be avoided if possible.

Hygienic measures are particularly important to keep the risk of infection as low as possible. Since the bacterium forms spores, the usual disinfectants are ineffective. For this reason the affected patients should be isolated.

The nursing staff should not do without careful hand washing, as the hand disinfectants cannot attack spores either. If the above mentioned therapy of pseudomembranous colitis is not sufficient, treatment with metronidazole or vancomycin is carried out over 7 days. It is important to ensure sufficient antibiotic treatment for at least 3 days after the diarrhea has subsided.

In this way, recurrences or resistances can be avoided. In 20% of cases, however, a relapse occurs after the end of therapy. The reason for this is that only active pathogens are killed by the antibiotic.

But not the spores, i.e. sleeping, inactive bacteria. These can become active after the antibiotic therapy and find excellent conditions for growth in the still attacked intestine. Such a relapse can again be treated relatively easily with metronidazole or vancomycin.

To prevent relapses, yeast preparations are used after the end of therapy. These help the intestine to regenerate faster and return it to its normal state. A stool transplant is the transfer of stool or the bacteria contained in stool from a healthy donor into the intestine of a patient.

The aim of stool transplantation is to restore the irreparably damaged intestinal flora of the patient and thus to produce or at least promote a physiological, i.e. healthy microbiome. To date, stool transplants have not been officially approved as a form of therapy, but are considered an “individual healing attempt” if the indication is accordingly established. However, the only common application is pseudomembranous colitis.

The performance of a stool transplantation begins with the preparation of the stool of a healthy donor. For this purpose, the donor stool is diluted with a physiological saline solution and then filtered, which cleans it of superfluous components such as indigestible fiber and dead bacteria. In most cases, the suspension produced in this way is then introduced into the patient’s duodenum via a probe that has previously been placed by means of endoscopy (mirroring). Another possibility is the introduction of the bacteria into the large intestine by means of colonoscopy.