Clostridium difficile infection following standard triple therapy for H. pylori eradication : a report of 3 cases
Session
Nursing and Medical Sciences
Description
Introduction/Aim: Even though it is not known how much resistance to clarithromycin is in our country, the therapy of choice for eradicating H. pylori continues to be the clarithromycin-based triple therapy. This 14-day therapy is generally well tolerated, with rare cases of mild side effects. However, although rarely in the literature, there are cases with severe side effects with pseudomembranous colitis. Infection with C. difficile causes a spectrum of diseases ranging from occasional diarrhoea to colitis, toxic megacolon, and death. Here we have presented three cases of C. difficile infection that appeared after eradication therapy with clarithromycin-based triple therapy. After therapy with oral vancomycin, the diarrhoea stopped completely.
Presentation of cases:
Case 1. A.B. 36-year-old female, reported due to frequent bowel movements, one month after receiving the two-week eradication therapy with clarithromycin, amoxicillin and pantoprazole. Lactose intolerance was suspected, but the genetic test for lactose intolerance was negative. After C. difficile toxin A and B were positive, a 14-day therapy with oral vancomycin 4x125 mg was prescribed. After 10 days, the stools stopped completely.
Case 2. B.B. 38-year-old male. Reported due to frequent stools three weeks after completion of eradication therapy with clarithromycin. Oral vancomycin 4x125mg was prescribed for 14 days. On the tenth day, stools stopped, and faeces began to form.
Case 3. G.Z. 25-year-old male. Three months after the end of eradication therapy, watery, bloodless stools appeared. Since C. difficile toxin A and B were positive, he was prescribed oral therapy with vancomycin 4x125 mg for 14 days. Towards the seventh day, the diaries left the terrace.
In all three cases, control tests for C. difficile toxin A and B were negative. Colonoscopy was not performed on any of the patients, since such a thing is not mandatory. Diagnosis is made only by tests of toxins A and B in faeces and not by culture.
Conclusion: These cases suggest that our doctors should have a high index of suspicion for pseudomembranous colitis in patients with diarrhoea after H. pylori eradication.
Keywords:
H. pylori eradication, triple therapy, C. difficile infection
Proceedings Editor
Edmond Hajrizi
ISBN
978-9951-550-95-6
Location
UBT Lipjan, Kosovo
Start Date
28-10-2023 8:00 AM
End Date
29-10-2023 6:00 PM
DOI
10.33107/ubt-ic.2023.205
Recommended Citation
Telaku, Skender; Islamaj, Edmond; Bajraktari, Burim; and Telaku, Mimoza, "Clostridium difficile infection following standard triple therapy for H. pylori eradication : a report of 3 cases" (2023). UBT International Conference. 9.
https://knowledgecenter.ubt-uni.net/conference/IC/med/9
Clostridium difficile infection following standard triple therapy for H. pylori eradication : a report of 3 cases
UBT Lipjan, Kosovo
Introduction/Aim: Even though it is not known how much resistance to clarithromycin is in our country, the therapy of choice for eradicating H. pylori continues to be the clarithromycin-based triple therapy. This 14-day therapy is generally well tolerated, with rare cases of mild side effects. However, although rarely in the literature, there are cases with severe side effects with pseudomembranous colitis. Infection with C. difficile causes a spectrum of diseases ranging from occasional diarrhoea to colitis, toxic megacolon, and death. Here we have presented three cases of C. difficile infection that appeared after eradication therapy with clarithromycin-based triple therapy. After therapy with oral vancomycin, the diarrhoea stopped completely.
Presentation of cases:
Case 1. A.B. 36-year-old female, reported due to frequent bowel movements, one month after receiving the two-week eradication therapy with clarithromycin, amoxicillin and pantoprazole. Lactose intolerance was suspected, but the genetic test for lactose intolerance was negative. After C. difficile toxin A and B were positive, a 14-day therapy with oral vancomycin 4x125 mg was prescribed. After 10 days, the stools stopped completely.
Case 2. B.B. 38-year-old male. Reported due to frequent stools three weeks after completion of eradication therapy with clarithromycin. Oral vancomycin 4x125mg was prescribed for 14 days. On the tenth day, stools stopped, and faeces began to form.
Case 3. G.Z. 25-year-old male. Three months after the end of eradication therapy, watery, bloodless stools appeared. Since C. difficile toxin A and B were positive, he was prescribed oral therapy with vancomycin 4x125 mg for 14 days. Towards the seventh day, the diaries left the terrace.
In all three cases, control tests for C. difficile toxin A and B were negative. Colonoscopy was not performed on any of the patients, since such a thing is not mandatory. Diagnosis is made only by tests of toxins A and B in faeces and not by culture.
Conclusion: These cases suggest that our doctors should have a high index of suspicion for pseudomembranous colitis in patients with diarrhoea after H. pylori eradication.