Clostridium difficile Colitis Following Head and Neck Surgery: Report of Cases

Pseudomemberanous Colitis following Cesarean Delivery with Adjunctive Intracolonic Vancomycin

“…Treating with oral or intravenous antimicrobial regimens has been shown to be unsuccessful mainly due to inadequate concentration of the drug in the colon [57][58][59]. There is some evidence available that adding intra colonic vancomycin, as an alternative route, can be promising as in 57%-75% of patients [60,[61][62][63][64][65][66][67][68][69][70]. Intravenous metronidazole, in some circumstances, produces fecal concentrations greater than the MIC needed for C. difficile; therefore, it may be an effective therapy [71].…”

“…Consequently, addition of ICV, administered by rectal enema or long catheters, is an alternative regimen especially in severely ill patients who have not responded to first-line therapy or are not eligible for it [60,[61][62][63][64][65][66][67][68][69][70].…”

Adjunctive Intracolonic Vancomycin for SevereClostridium difficileColitis: Case Series and Review of the Literature

“…In addition, the delivery of metronidazole was unpredictable in patients with ileus or toxic megacolon [8], and the amount of the drug and its metabolite detected declined over time as clinical resolution occurred [47]. Therefore, adjunctive ICV treatment administered by rectal enema or through long catheters is an alternative regimen for severely ill patients who either are not eligible for or do not respond to first-line therapeutic regimens [8,[33][34][35][36][37][38][39][40][41][42].…”

“…Griebie and Adams [33] reported success with adjunctive ICV therapy for C. difficile colitis for a patient who had undergone head and neck surgery and had severe ileus and colonic obstruction. Several case reports have claimed that adjunctive ICV therapy was effective for treatment of C. difficile colitis in patients with severe ileus or impaired oral intake [8,[34][35][36][37][38][39][40][41][42].…”

“…In our literature review, we identified successful outcomes in 20 (83.3%) of 24 episodes of C. difficile colitis treated with adjunctive ICV therapy [8,[33][34][35][36][37][38][39][40][41][42]. It is possible that inadequate delivery of ICV to the proximal colon contributed to treatment failure in some patients.…”