Pseudomembranous colitis following clarithromycin therapy.

OBJECTIVE

To describe the association of clarithromycin, used to treat Helicobacter pylori infection and duodenal ulceration, with pseudomembranous colitis in two patients.

SETTING

St Mary's Hospital, London, UK.

PATIENTS

Two female patients aged 77 and 78 years, admitted with duodenal ulceration and H. pylori infection.

INTERVENTION

Clarithromycin (500 mg three times daily) was administered concurrently with omeprazole (40 mg once daily).

OUTCOME MEASURES

After an initial improvement in symptoms both patients experienced persistent Clostridium difficile-associated diarrhoea.

CONCLUSIONS

High-dose clarithromycin should be used with caution for the treatment of H. pylori infection associated with gastroduodenal ulceration. The drug may induce antibiotic-associated colitis which can lead to morbidity and mortality, particularly in the elderly.