Research Article

Indications and Relative Utility of Lower Endoscopy in the Management of Clostridium difficile Infection

Table 4

Treatment: initial therapy, course/followup, overall outcome.

Initial therapy
Overall
Metronidazole
Vancomycin
Vanco + metronidazole

Treatment following lower GI endoscopy
 No change in therapy*27 (60%)1845
 Escalating medical therapy11 (26%)101
 Decreasing medical therapy2 (5%)2
 Surgery+3 (7%)12

Outcome
 Resolved28 (65%)2026
 Recurrent disease11 (26%)911
 Death4 (9%)13

*One patient in the no change in therapy group was on oral vancomycin (allergic to metronidazole) with bone marrow transplant and C. difficile, CMV, and graft versus host disease. The first endoscopy demonstrated a negative biopsy, and there was no change in therapy. The patient did not improve, and a second endoscopy was performed demonstrating PMC and on biopsy CMV colitis. He progressed to multisystem organ failure and died.
+One patient in the surgery category had two endoscopies: one endoscopy prior to surgery and one endoscopy after surgery to assess the ileostomy and mucus fistulotomy.