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Pseudomembranous Colitis, Bacterial Vaginosis,
and Antibiotics
by Brian Benjamin
Carter, MSci, LAc |
Brian,
I found your website and was very interested. Do you
have any natural remedies for someone with pseudomembranous
colitis (antibiotic associated colitis) who is suffering
from BV (bacterial vaginosis). I get very ill when I take
any of the antibiotics prescribed and currently have no
way to treat it and I am very concerned that it is not going
away.
Please let me know if you have any suggestions. Thank
you so much.
V.E.
Dear V,
This is a similar topic to our chronic diarrhea article (one of the most popular for some time). But it's different. We're dealing with a specific cause of stubborn
diarrhea and also the vaginosis. Since antibiotics are problematic
for you, we have to discuss alternative treatments.
First let's cover some of the basics... |
Article Contents:
|
Pseudomembranous Colitis (PMC) - An Antibiotic Colitis
PMC is a serious inflammation of the bowel lining with the formation of pseudomembranous plaques. The plaques are a yellow-green mucinous inflammatory exudate (yeah, I know, that's gross) that sit in patches throughout the lining of the colon and sometimes the small intestine.
PMC is an antibiotic-associated colitis. That means it happens after antibiotics unbalance the natural flora of the intestine. 1% of patients on antibiotics develop this condition. |
|
Clostridium (C.) difficile, a "bad" bacteria, is normally
present in the bowel in small quantites. But when antibiotics
destroy the "good" bacteria, C. difficile overgrows.
Then it releases a powerful toxin that causes the symptoms of
PMC...
Symptoms of Pseudomembranous Colitis
- Watery or mucoid green foul-smelling diarrhea
- Urge to defecate
- Abdominal cramps and pain
- Low-grade fever (although it can reach 103-105 F)
There may also be:
- Tenderness in the left lower quadrant of the abdomen (5-19%
of patients may have this tenderness without diarrhea. Stool
studies and CT scan aid in diagnosis)
- Bloody stool
- Signs of sepsis
Sepsis is hard to identify, but some signs and symptoms of it
are:
- Malaise (ill feeling)
- Fatigue
- Fever
- Rapid heart rate
- Low blood pressure
- Shock
I'm assuming your doctor already did a stool culture and got
a positive result for the C. difficile toxin, and did a colonoscopy
that showed the characteristic pseudomembranous plaques.
Conventional Treatment for PMC
Most commonly prescribed drugs are Metronidazole and Vancomycin.
Some other treatment are used too. Here is a chart to compare
them:
Treatment |
Administration |
Result |
Side Effects / Risks |
Vancomycin |
125 mg every 6 hours for 7-14 days for adults
500 mg/1.73 m2 every 6 hours for infants
|
Most reliable one - 90-100% response in adult
men |
May cause fever, lowered immune system, kidney
damage, hearing loss, eye tearing. |
Metronidazole (Flagyl) |
Dose of 250 mg 4 times per day for 7-10 days
is recommended. Not recommended for children or for women
during pregnancy |
Inexpensive and effective- 86-92% response
from adult men |
Can cause manic episodes
("antibiomania"), and may severely injure the liver
(rare or never) |
Bacitracin |
500-1000 mg 4 times per day for 7-19 days |
Symptomatic relief- Vancomycin better at
clearing C difficile from stool |
Low blood pressure, chest tightness, pain,
rash, itching, no appetite, nausea, vomiting, diarrhea, rectal
itching, sweating |
Teicoplanin |
500-1000 mg 2 times per day for 7-19 days |
Longer half-life than Vancomycin; less frequent
dosage required |
|
Cholestyramine |
4 grams 4 times per day |
For mild cases or relapse - response varies
and is generally low |
Constipation, heartburn, nausea, vomiting,
stomach pain, headache, bloating, belching, diarrhea |
Antidiarrheal agents (antiperstaltics) |
DON'T USE THEM |
May relieve symptoms but result in more damage
to intestines by keeping the toxin inside |
|
Lactobacillus GG |
The most successful studies involve the use
of Lactobacillus GG at a dose of 1 x 1010 viable organisms
per day |
Restores the natural flora to suppress the
C difficile |
Lactobacillus GG alone, or the combination
of Bifidobacterium bifidum and Streptococcus thermophilus,
is effective in the treatment of Clostridium difficile. Oral
administration of probiotic compounds has been demonstrated
to be well tolerated and safe. |
nonpathogenic yeast, such as Saccharomyces
boulardii |
|
Effective in treatment of multiple relapses |
|
Steroids (corticosteroids) |
|
Safe and effective for severe cases but not
recommended |
Insomnia, nervousness, increased appetite,
indigestion, excess body hair in women, diabetes, joint pain,
cataracts, glaucoma |
Diverting ileostomy or resection of diseased
bowel (subtotal colectomy) |
SURGERY
|
Was the standard before antibiotic therapy-
is now a life-saving measure in perforated cecum or toxic
megacolon |
|
Colostomy or ileostomy |
SURGERY
|
Gets antibiotics in directly in patients
with paralytic ileus |
|
Early subtotal colectomy |
SURGERY
|
For fulminant toxic cases that don't respond
after a week of intensive medical therapy because the risk
of perforation increases after 7 days of ineffective medical
therapy. |
|
Complications
With diarrhea, there is always a danger of dehydration. Refer
to the chronic diarrhea article.
The more serious complications of PMC are cecal perforation,
toxic megacolon, hemorrhage, and sepsis. These can be life-threatening,
so don't play around! Make sure you're under the care of a competent
physician who can help you identify these before it's too late.
Alternatives to Antibiotic Treatment
I think the Lactobacillus GG is pretty exciting (it's
in the chart above). There are a number of studies that confirm
its effectiveness or at least say it's promising.
It basically replaces the friendly flora that the antibiotics
destroyed. The GG form can survive the stomach acid and make it
to your intestines. (Note: The acidophilus form has been shown
to be destroyed by stomach acid so it never reaches the place
you want it to!)
Lactobacillus GG:
- Reduces the recurrence rate of Clostridium difficile
- Patients feel better when taking Lactobacillus GG, as compared
with the placebo, and
- Their abdominal cramps and diarrhea go away pretty quickly.
I'll give you this link. It may not be the only company that
offers GG, but I don't want you to accidentally buy a non-GG form
of Lactobacillus. Check out Culturelle.com.
No, I'm not making any money for referring you. Maybe I should!
Chinese Medicine Pseudomembranous Colitis Treatment
Now comes the fun part. What chinese herbal medicines can you
take for PMC?
If you've read the diarrhea article,
you may have noticed that the symptoms of PMC fit the chinese
medical disease Li Ji.
The Chinese Medical Disease: Li Ji
Li Ji (you can remember it by the rhyming word "leaky" - as in leaky... well you know!) can be divided into 6 major types.
It generally has the symptoms of:
- Increased frequency of bowel movements
- Tenesmus (straining to free the stool)
- Abdominal Pain
- Stool mixed with mucus, pus, and blood
However, the 6 types of Li Ji vary in their symptoms and signs.
Here's a table for ya:
Temp |
Type of
Li Ji
|
Unique Symptoms
|
Herbal Formula
|
Hot
|
Damp-heat
|
Burning sensation in anus,
dark scanty urine, fever, irritability, thirst |
Shao Yao Tang
|
Epidemic toxin
|
Sudden onset,
high fever, headache, thirst, irritability |
Bai Tou Weng Tang
|
Yin vacuity
|
Elimination of fresh blood
and thick mucus, burning pain in abdomen, loss of appetite,
irritability, thirst |
Zhu Che Wan
|
Cold
|
Cold-dampness
|
Sticky stools, more pus than blood, oppression
in chest and fullness in epigastrum, aversion to cold, preference
for warmth, loss of appetite, no thirst, heavy head and limbs |
Wei Ling Tang
|
Vacuity-cold
|
Liquid stool with pus, incontinence of stool,
dull cold abdominal pain, loss of appetite, fatigue, feel
cold, cold extremities, lower back ache |
Zhen Ren Yang Zang Tang
|
Chronic intermittent
|
recurring, no impovement over extended period
of time, tiredness, fatigue, lethargy, no appetite |
Lian Li Tang
|
The first two "hot" patterns are probably well-treated
by antibiotics. The third hot type may require a kind of yin supplementation
that western medicine doesn't use.
As for the cold patterns... We generally think of antibiotics
as being cold in nature, so they would do well against the hot
type of Li Ji. However, the cold type might be worsened by a cold
medicinal like an antibiotic. (If these ideas of cold and hot
are confusing, read my article "Heat
and Chilled Coffee")
The point is: Western medicine is not as able to deal with cold
and/or deficient types of diarrhea. That means people with the
last 4 types of Li Ji should see a Chinese Medicine practitioner.
How to Get a Chinese Herbal Formula for PMC
Get thee to a Chinese Medical Physician. That's basically the
same as an acupuncturist. I call them that because many of them
practice chinese herbal medicine too (acupuncture's just one modality-
not the whole medicine), and in California (where we set the standards
for the rest of the country) acupuncturists are physicians by
law.
To find one near you, consult this
resource. Call them up and make sure they prescribe personalized
herbal formulas. Patents, tinctures, and pills might not do the
trick in this case. Don't forget- you need to fix the PMC
fast because the complications are grave, the end of the line
is surgery, and chances of death are much higher if it gets bad
enough to require surgery.
FYI, some of the typical herbs we put in the formulas to treat
Li Ji are:
Type of
Li Ji
|
Herbal Formula
|
Major Herbs in Formula
|
Damp-heat
|
Shao Yao Tang
|
- Bai Shao Yao (White Peony root)
- Huang Lian (coptis root)
- Huang Qin (Scutellaria root)
|
Epidemic toxin
|
Bai Tou Weng Tang
|
- Bai Tou Weng (Pulsatilla root)
- Huang Bai (Phellodendron bark)
|
Yin vacuity
|
Zhu Che Wan
|
- Huang Lian (Coptis root)
- E Jiao (Donkey hide glue)
|
Cold-dampness
|
Wei Ling Tang
|
- Cang Zhu (Atractylodes root)
- Bai Zhu (Ovate Atractylodes root)
- Fu Ling (Poria)
|
Vacuity-cold
|
Zhen Ren Yang Zang Tang
|
- Ren Shen (Ginseng)
- Bai Zhu (Ovate Atractylodes root)
- Bai Shao Yao (White Peony root)
|
Chronic intermittent
|
Lian Li Tang
|
- Ren Shen (Ginseng)
- Bai Zhu (Ovate Atracylodes root)
- Huang Lian (Coptis root)
|
Kitchen Medicine
You may notice that one of the cold types includes ginseng. Good
kitchen medicine (use of herbs in the kitchen) for the cold types
of Li Ji might include fresh ginger tea, ginseng, or even garlic.
These herbs are too hot for the hot types... those with hot Li
Ji should avoid spicy and greasy foods.
Bacterial Vaginosis
Bacterial infections (bacterial vaginosis) usually cause a thin
grayish discharge that has an unpleasant, fishy smell. This type
of infection may be spread by sexual contact, but not in all cases.
Treatment of this condition requires antibiotics from a doctor.
Symptoms:
- You may notice a discharge from your vagina.
- The discharge may be clear or colored.
- It may be very light or heavy.
- It may have a fishy smell, especially after you have intercourse.
- Some women have bacterial vaginosis without any symptoms.
Is Sexually Transmitted?
It's not something you catch from someone else- it's an overgrowth
of normal vaginal bacteria. While it's more common in women who
are sexually active, it also occurs in women who are not sexually
active. It's not usually necessary for your sex partner to be
treated.
Complications
If the infection isn't treated, the bacteria may get up into
the uterus or the fallopian tubes and cause more serious infections.
Treating bacterial vaginosis lowers this risk. Treatment is especially
important in pregnant women.
Conventional Treatments
Treatment
|
Dosage
|
Cure rate
|
Metronidazole (Flagyl) |
500 mg twice daily for seven days or 2 g
in a single dose |
From 84 to 96 percent cure rate
Higher rate of recurrence with single
dose
|
Clindamycin |
300 mg twice daily for seven days |
94 percent
|
Clindamycin 2% vaginal cream |
5 g at bedtime for seven days |
86 percent (estimated)
|
Metronidazole vaginal gel |
5 g twice daily or at bedtime for five days
|
75 percent
|
Alternative Treatments for Bacterial Vaginosis
(to be take with a figurative "Grain of Salt")
I found a number of other alternative treatments online- I must
say that I don't know how much they've been studied- someone out
there may have some info I don't... in which case I ask you to
email me about it.
First, some recommend to AVOID:
- alcohol
- coffee
- fast foods
- processed foods
- refined flour products (bread, pasta, etc.)
- saturated fats from animal products
- sugar
However, a lot of people suggest avoiding those things at all
time for all conditions! Generally, unhealthy foods are harder
on the digestion system- maybe that's the point.
Here's a list of the things people suggest you SHOULD TAKE:
- flax seed (Linseed) meal and oil
- fresh vegetables and fruits
- grains
- meats, including fish, poultry
- plenty of fresh water
- Vitamin C (1,000 mg three times daily with meals)
- Zinc (30 mg daily)
- Bromelain (400mg)
- Wobenzme N (5 tablets three times a day away from meals)
- Goldenseal (Hydrastis canadensis) vaginal suppositories
- Goldenseal/Vitamin A vaginal suppository twice daily
- Warm sitz baths with tea tree oil (Melaleuca alternifolia)
- Vaginal douching using:
· Goldenseal (Hydrastis canadensis)
· Oregon Grape Root (Mahonia aqjuifolium)
Chinese Medicine for Bacterial Vaginosis
Broken record- see a Chinese Medicine practitioner. There are
herbs that could be used as a douche, and there are internal herbal
approaches too. Probably the best approach would be to do both...
or to use an internal herbal formula for the PMC and an external
one for the vaginosis.
Find a practitioner
here.
References
- Radiology
Department of the University of Connecticut Health Center
- Medline
Plus Health Information
- SurgicalTutor.org.uk
- Wu, Fischer. Practical
Therapeutics of Traditional Chinese Medicine. Paradigm Publications,
1997.
- Kelly C P, Pothoulakis C, Lamont J T. Clostridium difficle
colitis. NEJM 1994; 330: 257-262.
- Cleary R K. Clostridium difficle-associated diarrhea and colitis.
Dis Colon Rectum 1998; 41: 1435-1449.
- Aronsson B, Mollby R, Nord CE: Diagnosis and epidemiology
of Clostridium difficile enterocolitis in Sweden. J Antimicrob
Chemother 1984 Dec; 14 Suppl D: 85-95.
- Bartlett JG: Antibiotic-associated pseudomembranous colitis.
Rev Infect Dis 1979 May-Jun; DA - 19801120(3): 530-9.
- Bartlett JG: Clostridium difficile: clinical considerations.
Rev Infect Dis 1990 Jan-Feb; 12 Suppl 2: S243-51.
- Bartlett JG, Chang TW, Gurwith M: Antibiotic-associated pseudomembranous
colitis due to toxin-producing clostridia. N Engl J Med 1978
Mar 9; 298(10): 531-4.
- Bingley PJ, Harding GM: Clostridium difficile colitis following
treatment with metronidazole and vancomycin. Postgrad Med J
1987 Nov; 63(745): 993-4.
- Bradley SJ, Weaver DW, Maxwell NP: Surgical management of
pseudomembranous colitis. Am Surg 1988 Jun; 54(6): 329-32
- de Lalla F, Nicolin R, Rinaldi E: Prospective study of oral
teicoplanin versus oral vancomycin for therapy of pseudomembranous
colitis and Clostridium difficile- associated diarrhea. Antimicrob
Agents Chemother 1992 Oct; 36(10): 2192-6
- Eglinton GS, Mayes GR, Potts DW: Pseudomembranous colitis
unresponsive to oral vancomycin therapy. South Med J 1982 Oct;
75(10): 1279-80
- George WL: Antimicrobial agents associated diarrhea in adult
humans. In: Rolfe RD, Finegold SM, eds. Clostridium difficile:
Its role in intestinal disease. San Diego, Calif: Academic Press;
1988: 32-41.
- Gorbach SL, Chang TW, Goldin B: Successful treatment of relapsing
Clostridium difficile colitis with Lactobacillus GG. Lancet
1987 Dec 26; 2(8574): 1519
- Johnson S, Adelmann A, Clabots CR: Recurrences of Clostridium
difficile diarrhea not caused by the original infecting organism.
J Infect Dis 1989 Feb; 159(2): 340-3
- McFarland LV: Epidemiology, risk factors and treatments for
antibiotic-associated diarrhea. Dig Dis 1998 Sep-Oct; 16(5):
292-307
- eMedicine
- PMC
- Pochapin M. The effect of probiotics on Clostridium difficile
diarrhea. Am J Gastroenterol 2000 Jan;95(1 Suppl):S11-3
- Arvola T, Laiho K, Torkkeli S, Mykkanen H, Salminen S, Maunula
L, Isolauri E. Prophylactic Lactobacillus GG reduces antibiotic-associated
diarrhea in children with respiratory infections: a randomized
study. Pediatrics. 1999 Nov;104(5):e64.
- Guandalini S. The treatment of acute diarrhea in the third
millennium: a pediatrician's perspective. Acta Gastroenterol
Belg 2002 Jan-Mar;65(1):33-6
- Madsen KL. The use of probiotics in gastrointestinal disease.
Can J Gastroenterol 2001 Dec;15(12):817-22.
- Elmer GW. Probiotics: "living drugs". Am J Health
Syst Pharm 2001 Jun 15;58(12):1101-9.
- eMedicine
- BV
- BV
Alternative Treatments
- Women's
Health - Vulvovaginitis
- Abouesh A, Stone C, Hobbs WR. Antimicrobial-induced mania
(antibiomania): a review of spontaneous reports. J Clin Psychopharmacol.
2002 Feb;22(1):71-81. Review.
- Lopes Rocha JL, Kondo W, Domingues Kuchiki Baptista MI, Arns
Da Cunha C, Flenik Martins LT. Uncommon vancomycin-induced side
effects. Braz J Infect Dis. 2002 Aug;6(4):196-200.
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