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A Note of Caution on Empiric Use of Ciprofloxacin for Diarrhea-Reply

LARRY J. Goodman, MD; John Segreti, MD; Gordon M. Trenholme, MD
Arch Intern Med. 1992;152(1):217. doi:10.1001/archinte.1992.00400130199041.
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In Reply. —  Clostridium difficile colitis is a complication seen after treatment with many classes of antimicrobial agents. This can be a particularly difficult diagnosis to make when diarrhea due to C difficile develops as a complication of treatment of a different diarrheal disease. Manzione's case illustrates that the recognition of C difficile as a separate infection in this setting requires a high index of suspicion.Quinolone therapy appears to be relatively infrequently complicated by C difficile disease.1 In fact, several investigators2-4 have suggested a potential therapeutic role for quinolones in C difficile diarrhea, although it remains unproven. Nevertheless, we agree with the cautionary note of Manzione concerning the treatment of domestically acquired diarrhea, and we believe that our article conveyed the same concerns.

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