Which medications in the drug class Bile Acid Sequestrants are used in the treatment of Clostridioides (Clostridium) Difficile Colitis?

Updated: Jul 25, 2019
  • Author: Faten N Aberra, MD, MSCE; Chief Editor: BS Anand, MD  more...
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Bile Acid Sequestrants

Bile acid sequestrants bind C difficile toxin and other proteins. Although not as effective as primary therapy for C difficile, the advantage of bile acid sequestrant therapy is that it does not alter the gut microflora.

Cholestyramine (Questran)

Cholestyramine is used to treat diarrhea associated with pseudomembranous colitis. This agent forms a nonabsorbable complex with bile acids in the intestine, which, in turn, inhibits the enterohepatic reuptake of intestinal bile salts.

Note that cholestyramine binds vancomycin, which precludes combination therapy. This agent is available as a powder that must be mixed with water prior to ingestion. The efficacy of cholestyramine is inferior to that of metronidazole or vancomycin, but the drug may have a role under certain circumstances (eg, in patients who continue to relapse). This agent is not absorbed from the GI tract.

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