Concluding remarks — the unanswered questions
Despite the tremendous increase in our understanding of C. difficile mediated gastrointestinal disease made over the last five years a great number of important questions remain unanswered. Although it is known that most antibiotics, and even in some cases non-antimicrobial chemotherapeutic agents, will induce disease, it is not known why some antibiotics have a higher associated risk than others or why the parenterally administered aminoglycosides carry a very low risk. In the majority of cases cessation of the offending antibiotic is sufficient to bring about resolution of symptoms within 10 to 14 days. This raises the possibility that specific treatment directed against C. difficile may occasionally exacerbate the situation over the long term by inducing a series of relapses of which some may progress to pseudomembranous colitis. It appears tha not, all adult patients who carry C. difficile progress from antibiotic-associated diarrhoea through antibiotic-associated colitis to pseudomembranous colitis. How could we differentiate those patients who would suffer only a mild self-limiting diarrhoea from those who would develop life threatening disease if left untreated? It would be interesting to know what factors are involved in determining the type of disease a patient will develop.
KeywordsAsymptomatic Carriage Pseudomembranous Colitis Faecal Specimen Tremendous Increase Mucosal Lining
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