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Br Med J. 1978 December 16; 2(6153): 1667–1669.
PMCID: PMC1609009

Randomised controlled trial of vancomycin for pseudomembranous colitis and postoperative diarrhoea.


The efficacy of vancomycin in pseudomembranous colitis was assessed in a prospective randomised controlled trial. Forty-four patients with postoperative diarrhoea were allocated to five days' treatment with either 125 mg vancomycin six-hourly or a placebo. Sixteen patients had high titres of the neutralised faecal toxin characteristic of pseudomembranous colitis; nine received vancomycin and seven placebo. At the end of treatment faecal toxins were present in one patient given vancomycin compared with five of the controls. Vancomycin caused the disappearance of Clostridum difficile from the stool in all except one patient, whereas toxicogenic strains of Cl difficile persisted in all but one of the controls. Histological evidence of psuedomembranous colitis had disappeared by the end of treatment in six out of seven patients given vancomycin compared with only one out of seven patients given vancomycin compared with only one out of five patients given placebo. In patients with faecal toxins bowel habit had returned to normal in seven of the vancomycin group compared with only one of the controls, but there was no significant difference in clinical response among patients without faecaal toxins. The results suggest that vancomycin eliminates toxin-producing Cl difficile from the colon and is associated with rapid clinical and histological improvement in patients with pseudomembranous colitis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Scott AJ, Nicholson GI, Kerr AR. Lincomycin as a cause of pseudomembranous colitis. Lancet. 1973 Dec 1;2(7840):1232–1234. [PubMed]
  • Larson HE, Price AB, Honour P, Borriello SP. Clostridium difficile and the aetiology of pseudomembranous colitis. Lancet. 1978 May 20;1(8073):1063–1066. [PubMed]
  • Bartlett JG, Chang TW, Gurwith M, Gorbach SL, Onderdonk AB. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia. N Engl J Med. 1978 Mar 9;298(10):531–534. [PubMed]
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  • Khan MY, Hall WH. Staphylococcal enterocolitis--treatment with oral vancomycin. Ann Intern Med. 1966 Jul;65(1):1–8. [PubMed]
  • Tedesco F, Markham R, Gurwith M, Christie D, Bartlett JG. Oral vancomycin for antibiotic-associated pseudomembranous colitis. Lancet. 1978 Jul 29;2(8083):226–228. [PubMed]
  • Price AB, Davies DR, Morson BC. Proceedings: The diagnosis of pseudomembranous colitis by rectal biopsy. Gut. 1974 Apr;15(4):346–347. [PubMed]
  • Tedesco FJ, Barton RW, Alpers DH. Clindamycin-associated colitis. A prospective study. Ann Intern Med. 1974 Oct;81(4):429–433. [PubMed]

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