Antibiotic associated diarrhoea and enterocolitis.

ABSTRACT

C. difficile is the major aetiological agent of AAD and PMC and results from overgrowth of C. difficile already present endogenously or of newly acquired exogenous organisms after suppression of competing gut flora. C. difficile produces two kinds of toxins A and B. These toxins attack the colonic mucosa which becomes necrotic with the formation in fulminating cases of an exudative pseudomembrane. Toxigenic and non-toxigenic strains of C. difficile may be present together in an individual suffering from AAD. There is substantial variation among strains with respect to the quantity of lethal toxin produced. There are several strategies available for the investigation of C. difficile associated disease. Detection of toxins by neutralization with C. sordelli antitoxin is an easy, simple and sensitive method. Methods to deal effectively with silent carriers are not known because the routine administration of antibiotic treatment in an attempt to eradicate the carrier state would in fact boomerang by promoting C. difficile associated enteric disease rather than eliminating C. difficile.