Clinical Aspects of Rifampicin-associated Pseudomembranous Colitis

Abstract

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.

Emergence of Clostridium difficile infection in tuberculosis patients due to a highly rifampicin-resistant PCR ribotype 046 clone in Poland

“…Anti-tuberculosis agents are very rarely associated with CDI [2–4]. Agents such as isoniazid and pyrazinamide have little or no effect on the intestinal flora, but rifampicin has an antibiotic effect on a wide range of bacteria [17].…”

“…Anti-tuberculosis drugs are not commonly associated with the development of CDI [2–5]. Recently, FQ have been linked to CDI, particularly those cases caused by polymerase chain reaction (PCR) ribotype 027 [6, 7].…”

Development of Pseudomembranous Colitis Four Months after Initiation of Rifampicin

“…Rare cases of rifampicin-associated PMC have been reported since the 1980s [3, 4, 5, 6, 7]. Among antitubercular agents, rifampicin has been implicated as a cause of PMC due to its relatively wide range of antibiotic effects, whereas isoniazid and ethambutol have few effects on the intestinal flora [3].…”

The First Case of Antibiotic-associated Colitis by Clostridium difficile PCR Ribotype 027 in Korea

“…The most common inducing agents have been known to be clindamycin and the broad-spectrum cephalosporin, but nearly all agents with an antibacterial spectrum may be responsible (1-4). On the other hand, anti-tuberculosis agents are rarely associated with this disorder (1, 5). Among these agents, rifampin is postulated to be the cause of PMC, because it has an antibiotic effect on a wide range of bacteria, whereas isoniazid and ethambutoal had little or no effect on the intestinal flora (13).…”

“…Fulminant colitis develops in approximately 1 to 3% of the patients, leading to ileus, toxic megacolon, perforation, and death (1). PMC is known to develop after the antibiotic administration, whereas the antituberculosis agents are rarely associated with this disorder (1, 5). …”