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iver. diarrhea, abdominal pain or fStention. It is confirmed by sig-loidoscopy with the finding of icam-colored tenacious plaques ith the intervening mucosa being -ythematous and edematous. The patients presented above sre seriously ill with high fever, ukocytosis and immature forms in e peripheral blood. In the 20 cases ported in detail in the literature, hite cell counts varied from 11.500 iljj ' 34.000 with all but two greater Tic.^ an 16.000/mm^. Fever in all but u- /o of the 20 was greater than 101° (j . 2.3.5-11 r. Protracted disability in otherwise eii| iaithy young people was a striking -1 ature. both in our patients and in :::: lose described by others. It ranged in^ om one week to several months, p; ith a median and mean of five . i eeks. That this can be a serious li- ness is demonstrated by the fact lat of these 24 patients, two died id two others required extended i!}|3spital stays. Ages ranged from 9 iii|) 74. with a mean of 46. One-third j[cl r the patients were under 35. A ie; Dtable feature is that the majority if patients (19 of 24) were women. : The most consistent chemical ab-ormality in our cases was the low ifi|srum albumin primarily from pro-nn loss via the gastrointestinal •act. As demonstrated by Case 3. it^l scites and pleural effusions may from the hypoalbuminemia !i:) nd the requirement for albumin re-lacement may be extensive. In two four patients, elevated SCOT and Ikaline phosphatase levels were oted, returning to normal with re-overy. Mild transient elevation of GPT and SGOT. or alkaline phosphatase was noted in 8 of 19 patients iven clindamycin in one study. io evidence of colitis was reported. Elmore and colleagues reported a larked rise in SGOT and an ab-ormal liver biopsy following in-ravenous clindamycin therapy Fig. 2. Gross appearance of colon from Case # 4. Note the diffuse and extensive involvement. which quickly resolved after cessation of therapy.^^ The nature of this defect in hepatic function and its relation to colitis remains obscure. In view of these experiences, we believe the use of clindamycin should be reserved for those specific clinical situations in which it is clearly the antibiotic of choice. The potential significance of diarrhea, fever or abdominal pain in a patient receiving clindamycin therapy is evident. Continued fever, diarrhea, marked leukocytosis or hypoalbuminemia should be watched for and viewed with suspicion. Detection of this complication by a high index of suspicion and by early sigmoidoscopy may decrease the severity and length of debility. Treatment is non-specific and includes discontinuance of the antibiotic. supportive care, albumin replacement and lactobacillus acidophilus. Burbige and Milligan have recently reported prompt re- mission of symptoms in this entity with cholestyramine in one patient.'"^ Relerences 1 Geddes AM. Bndguater |-A, VKilliams DN. et al- Clinical and bacteriologi<:al studies with cimdamvcm Bnt Med J :.703-7(U. 1970 : Cohen LE. McNeill CJ, Uells RI-: flindamycin- associated colitis JAM A 1579-1380. 1973 3 Shimkin FM. Link RJ: Pseudomembranous colitis: a consideration in (he barium enema dillerential diagnosis ol acuie generalized ulcerati\e colitis Bnt J Radiol 4ft 437-439. 1973 4. Tedesco hJ. Barton . Alpers DH Diagnostic lea-tures ot clindamvcin-associated pseudomembranous colitis. N Eng J Med :j<0 M3. 1974 5 Siroehlein JR. Sedla^k RE. Hoitman HN Znd Clmdamvcin-associated colitis Mayo Clin Hroc 49::40-:43. 1974 ft. Viteri Al.. Paxton HH. Dyck P. The spectrum ot lincom \cm-clmdamvcin colitis Gastri.)enterologv ftft 1)37-1144. 1974 7 Dehord JN^. Mohnaro JR. Dalv JJ Lincomycin- and clindamvcin-associated colitis Gastromtest Endosc 21:19-21. 1974 5. Hunter Kj Clmdamvcin-associated colitis. J Maine Med Assoc ft.^ 302-303, 305. 1974 9 Da\is JS Se\ere colitis lollov\ing Imcomycin and clin-damvcin therap\. Am J Gastroenterol ft2.lft-23. 1974 10. Wolle MS: JAMA 2:9:2ftft-2ft7. 1974 11 Pastore RA Kadair RG' H> poalbummemia. ascites and pseudomembranous colitis atter clindamycin therapy. South Med J h7:^65•i^ft^; 1974 12. Pass R.I. Scholand JP. Hodges GR, Saslav^ S. Clindamycin in the treatment oi serious anaerobic iniec-tions Ann Intern Med 7s:s53-?i59. |973 13 Elmore M, Rissing JP. Rink L, Brooks Gl Clindamvcin-associated hepatotoxicitv Am J Med 57 ft:7-ft30. 14. Burbigc EJ, Milligan PD Pseudomembranous colitis: association vmth antibH)tics and iherap\ uith cholestyramine JAMA 231:1157-1158. 1975. . . . I am convmced the great majority of those complaints which are considered purely mental, such as irntability and irascibility of temper, gloomy melancholy, timidity and irresolution, despondency. &c. might be greatly remedied, if not entirely removed, by a proper system of temperance, and with very little medicine. On this account, medical men often have it in their power to confer an immense boon of happmess on many valuable members of society, whose lives are rendered wretched by morbid sensitiveness of the mind, having its unsuspected source m morbid sensibility of the stomach, bowels, or nervous system.—A/? Ess(2v on Indi^esiion: or Morbid Sensihilitx of the Stomach Bow els, James Johnson, 1836. p 8. 4arch 1976. N'CMJ 143
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-Present] |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1976 |
Identifier | NCHH-17-037 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 37 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-037.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-037 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 143 (image) |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1976 |
Identifier | NCHH-17-037-0161 |
Form General | Periodicals |
Page Type | all; all images; photo; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncarolinamed371976medi_0161.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 37 |
Issue Number | 3 |
Page Number | 143 |
Health Discipline | Medicine |
Full Text | iver. diarrhea, abdominal pain or fStention. It is confirmed by sig-loidoscopy with the finding of icam-colored tenacious plaques ith the intervening mucosa being -ythematous and edematous. The patients presented above sre seriously ill with high fever, ukocytosis and immature forms in e peripheral blood. In the 20 cases ported in detail in the literature, hite cell counts varied from 11.500 iljj ' 34.000 with all but two greater Tic.^ an 16.000/mm^. Fever in all but u- /o of the 20 was greater than 101° (j . 2.3.5-11 r. Protracted disability in otherwise eii| iaithy young people was a striking -1 ature. both in our patients and in :::: lose described by others. It ranged in^ om one week to several months, p; ith a median and mean of five . i eeks. That this can be a serious li- ness is demonstrated by the fact lat of these 24 patients, two died id two others required extended i!}|3spital stays. Ages ranged from 9 iii|) 74. with a mean of 46. One-third j[cl r the patients were under 35. A ie; Dtable feature is that the majority if patients (19 of 24) were women. : The most consistent chemical ab-ormality in our cases was the low ifi|srum albumin primarily from pro-nn loss via the gastrointestinal •act. As demonstrated by Case 3. it^l scites and pleural effusions may from the hypoalbuminemia !i:) nd the requirement for albumin re-lacement may be extensive. In two four patients, elevated SCOT and Ikaline phosphatase levels were oted, returning to normal with re-overy. Mild transient elevation of GPT and SGOT. or alkaline phosphatase was noted in 8 of 19 patients iven clindamycin in one study. io evidence of colitis was reported. Elmore and colleagues reported a larked rise in SGOT and an ab-ormal liver biopsy following in-ravenous clindamycin therapy Fig. 2. Gross appearance of colon from Case # 4. Note the diffuse and extensive involvement. which quickly resolved after cessation of therapy.^^ The nature of this defect in hepatic function and its relation to colitis remains obscure. In view of these experiences, we believe the use of clindamycin should be reserved for those specific clinical situations in which it is clearly the antibiotic of choice. The potential significance of diarrhea, fever or abdominal pain in a patient receiving clindamycin therapy is evident. Continued fever, diarrhea, marked leukocytosis or hypoalbuminemia should be watched for and viewed with suspicion. Detection of this complication by a high index of suspicion and by early sigmoidoscopy may decrease the severity and length of debility. Treatment is non-specific and includes discontinuance of the antibiotic. supportive care, albumin replacement and lactobacillus acidophilus. Burbige and Milligan have recently reported prompt re- mission of symptoms in this entity with cholestyramine in one patient.'"^ Relerences 1 Geddes AM. Bndguater |-A, VKilliams DN. et al- Clinical and bacteriologi<:al studies with cimdamvcm Bnt Med J :.703-7(U. 1970 : Cohen LE. McNeill CJ, Uells RI-: flindamycin- associated colitis JAM A 1579-1380. 1973 3 Shimkin FM. Link RJ: Pseudomembranous colitis: a consideration in (he barium enema dillerential diagnosis ol acuie generalized ulcerati\e colitis Bnt J Radiol 4ft 437-439. 1973 4. Tedesco hJ. Barton . Alpers DH Diagnostic lea-tures ot clindamvcin-associated pseudomembranous colitis. N Eng J Med :j<0 M3. 1974 5 Siroehlein JR. Sedla^k RE. Hoitman HN Znd Clmdamvcin-associated colitis Mayo Clin Hroc 49::40-:43. 1974 ft. Viteri Al.. Paxton HH. Dyck P. The spectrum ot lincom \cm-clmdamvcin colitis Gastri.)enterologv ftft 1)37-1144. 1974 7 Dehord JN^. Mohnaro JR. Dalv JJ Lincomycin- and clindamvcin-associated colitis Gastromtest Endosc 21:19-21. 1974 5. Hunter Kj Clmdamvcin-associated colitis. J Maine Med Assoc ft.^ 302-303, 305. 1974 9 Da\is JS Se\ere colitis lollov\ing Imcomycin and clin-damvcin therap\. Am J Gastroenterol ft2.lft-23. 1974 10. Wolle MS: JAMA 2:9:2ftft-2ft7. 1974 11 Pastore RA Kadair RG' H> poalbummemia. ascites and pseudomembranous colitis atter clindamycin therapy. South Med J h7:^65•i^ft^; 1974 12. Pass R.I. Scholand JP. Hodges GR, Saslav^ S. Clindamycin in the treatment oi serious anaerobic iniec-tions Ann Intern Med 7s:s53-?i59. |973 13 Elmore M, Rissing JP. Rink L, Brooks Gl Clindamvcin-associated hepatotoxicitv Am J Med 57 ft:7-ft30. 14. Burbigc EJ, Milligan PD Pseudomembranous colitis: association vmth antibH)tics and iherap\ uith cholestyramine JAMA 231:1157-1158. 1975. . . . I am convmced the great majority of those complaints which are considered purely mental, such as irntability and irascibility of temper, gloomy melancholy, timidity and irresolution, despondency. &c. might be greatly remedied, if not entirely removed, by a proper system of temperance, and with very little medicine. On this account, medical men often have it in their power to confer an immense boon of happmess on many valuable members of society, whose lives are rendered wretched by morbid sensitiveness of the mind, having its unsuspected source m morbid sensibility of the stomach, bowels, or nervous system.—A/? Ess(2v on Indi^esiion: or Morbid Sensihilitx of the Stomach Bow els, James Johnson, 1836. p 8. 4arch 1976. N'CMJ 143 |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-037.pdf |
Document Sort | all; nchh-17 |
Article Title | Pseudomembranous Colitis Following Clindamycin Therapy |
Article Author | Robert D. Stratton; James L. Lapis; Eugene M. Bozymski |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-037 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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