Internal Medicine

P1: SBT

0521779407-03a CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:18

Antibiotic-Associated Colitis Antiphospholipid Antibodies 135

■severely ill patients who cannot tolerate oral medication: metron-

idazole IV and/or vancomycin enemas

■surgery reserved for those with peritoneal signs, impending perfo-

ration, persistent toxic megacolon and refractory septicemia

■surgery of choice subtotal colectomy with ileostomy; can be con-

verted to an ileorectal anastomosis once the patient has recovered

Treatment of Recurrent Infection

■first relapse treated the same way as the initial episode with 10–14

days of oral metronidazole or vancomycin

■treatment for multiple relapses:

➣tapering and pulsed antibiotic treatment: metronidazole or van-

comycin administered every other day or every third day as they

are tapered over the course of 4–6 weeks

➣use of oral anion-binding resins such as colestipol or choles-

tyramine; given in addition to antibiotics, usually vancomycin,

for a period of two weeks

➣other alternatives: oral lactobacillus strain GG, oral Saccharo-

myces boulardii with or without antibiotics, intravenous gamma

globulin

Side Effects & Complications

■antibiotics used for the treatment of C. difficile are known to also

cause C. difficile infection

■anion-binding resins can cause significant abdominal bloating

follow-up

■no need to confirm a patient is C. difficile toxin negative after com-

pletion of treatment as long as patient is asymptomatic

complications and prognosis

■good, particularly for those who do not experience relapse

Antiphospholipid Antibodies............................

MICHELLE A. PETRI, MD MPH

history & physical

■Antiphospholipid antibodies (lupus anticoagulant, anticardiolipin,

anti-beta2 glycoprotein I) are a marker for hypercoagulability.

■Fifty percent of patients with antiphospholipid antibodies have sys-

temic lupus erythematosus.