Pseudomembranous Colitis, Bacterial Vaginosis, and Antibiotics

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Pseudomembranous Colitis, Bacterial Vaginosis, and Antibiotics

by Brian Benjamin Carter

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:

 

TreatmentAdministrationResultSide Effects / RisksVancomycin

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 menMay 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 pregnancyInexpensive and effective- 86-92% response

from adult menCan cause manic episodes ( " antibiomania " ), and may severely injure

the liver (rare or never)Bacitracin500-1000 mg 4 times per day for 7-19

daysSymptomatic relief- Vancomycin better at clearing C difficile from stoolLow

blood pressure, chest tightness, pain, rash, itching, no appetite, nausea,

vomiting, diarrhea, rectal itching, sweatingTeicoplanin500-1000 mg 2 times per

day for 7-19 daysLonger half-life than Vancomycin; less frequent dosage

requiredCholestyramine4 grams 4 times per dayFor mild cases or relapse -

response varies and is generally lowConstipation, heartburn, nausea, vomiting,

stomach pain, headache, bloating, belching, diarrheaAntidiarrheal agents

(antiperstaltics)DON'T USE THEMMay relieve symptoms but result in more damage to

intestines by keeping the toxin insideLactobacillus GGThe most successful

studies involve the use of Lactobacillus GG at a dose of 1 x 1010 viable

organisms per dayRestores the natural flora to suppress the C

difficileLactobacillus 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

boulardiiEffective in treatment of multiple relapsesSteroids

(corticosteroids)Safe and effective for severe cases but not

recommendedInsomnia, nervousness, increased appetite, indigestion, excess body

hair in women, diabetes, joint pain, cataracts, glaucomaDiverting ileostomy or

resection of diseased bowel (subtotal colectomy)SURGERYWas the standard before

antibiotic therapy- is now a life-saving measure in perforated cecum or toxic

megacolonColostomy or ileostomySURGERYGets antibiotics in directly in patients

with paralytic ileusEarly subtotal colectomySURGERYFor 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!

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:

 

TempType of

Li Ji Unique SymptomsHerbal FormulaHotDamp-heatBurning sensation in anus, dark

scanty urine, fever, irritability, thirstShao Yao TangEpidemic toxinSudden

onset, high fever, headache, thirst, irritabilityBai Tou Weng TangYin

vacuityElimination of fresh blood and thick mucus, burning pain in abdomen, loss

of appetite, irritability, thirstZhu Che WanColdCold-dampnessSticky 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

limbsWei Ling TangVacuity-coldLiquid stool with pus, incontinence of stool, dull

cold abdominal pain, loss of appetite, fatigue, feel cold, cold extremities,

lower back acheZhen Ren Yang Zang TangChronic intermittentrecurring, no

impovement over extended period of time, tiredness, fatigue, lethargy, no

appetiteLian 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

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 FormulaMajor Herbs in FormulaDamp-heatShao Yao Tang

Bai Shao Yao (White Peony root)

Huang Lian (coptis root)

Huang Qin (Scutellaria root)

Epidemic toxinBai Tou Weng Tang

Bai Tou Weng (Pulsatilla root)

Huang Bai (Phellodendron bark)

Yin vacuityZhu Che Wan

Huang Lian (Coptis root)

E Jiao (Donkey hide glue)

Cold-dampnessWei Ling Tang

Cang Zhu (Atractylodes root)

Bai Zhu (Ovate Atractylodes root)

Fu Ling (Poria)

Vacuity-coldZhen Ren Yang Zang Tang

Ren Shen (Ginseng)

Bai Zhu (Ovate Atractylodes root)

Bai Shao Yao (White Peony root)

Chronic intermittentLian 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

TreatmentDosageCure rateMetronidazole (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

Clindamycin300 mg twice daily for seven days 94 percentClindamycin 2% vaginal

cream5 g at bedtime for seven days 86 percent (estimated)Metronidazole vaginal

gel5 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)

for Bacterial Vaginosis

Broken record- see a 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

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eMedicine - PMC

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eMedicine - BV

BV Alternative Treatments

Women's Health - Vulvovaginitis

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