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2625 pages added, reviewed or updated during the last month (last updated: 15/4/2021)

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pseudomembranous colitis

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Pseudomembranous colitis is a very severe form of antibiotic associated colitis or diarrhoea. It is usually the result of the toxin of Clostridium difficile.

Most cases are hospital-acquired. Infection is faeco-oral, for example, via the patient's or staff's hands from a contaminated commode or equipment - rectal thermometer, sigmoidoscope, etc. Sixty percent of cases occur in the elderly.


  • Clostridium difficile toxins (A and B)


  • Human gastrointestinal tract
  • Spores may be present on environmental surfaces contaminated by symptomatic persons


  • person-to-person spread from symptomatic patients either directly or indirectly via contaminated hands of healthcare/other care workers
  • via contact with environmentally contaminated surfaces e.g. commodes
  • spread does not occur from asymptomatic carriers
  • (1)

Incubation period:

  • difficult to establish incubation period
  • among patients commencing antibiotics, diarrhoea usually starts within 1-2 days of commencing antibiotics but can occur several weeks after antibiotic treatment


  • Most infectious when symptomatic
  • Infectiousness reduces with treatment and decreasing severity of symptoms
  • Stopping the implicated antibiotics (if possible) may be indicated


  • C. difficile spores are hardy and may remain on environmental surfaces for many weeks. Thorough environmental cleaning with suitable agents e.g. chlorine containing products is required to reduce transmission


  • PHE (2019). Recommendations for the Public Health Management of Gastrointestinal Infections

Last edited 02/2020