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» LymeNet Flash » Questions and Discussion » Medical Questions » C-Diff Questions and going back on Abx

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Author Topic: C-Diff Questions and going back on Abx
Connieaag
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Interested in knowing how long after a C-Diff infection you waited to resume Abx again, or if you are ever really able to effectively tolerate them well.

My daughter is fighting a C-Diff infection. Flagyl did nothing for it. Xifaxan is working with the standard 3 day course, but a day after that ended she had D again. So she's back on it.

See Dr. C on Monday so we will discuss this with him as all of this has transpired over the last 2+ months and was handles by her PCP and a pediatric Gastro -- coloscopy/endo, etc.

Thanks!

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FuzzySlippers
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Hi Connie,

I'm so sorry to hear about your daughter's C. Diff infection. I've had to contend with this as well.

I first got C.Diff three years ago when I was re-infected with Lyme/Co's. It was before I had even started treatment for Lyme. And I just got a second bout of it this past September.

This most recent C. Diff episode required me to be off Lyme/Co treatment for about 5 weeks while I tried to tackle the C.Diff. Flagyl did not work for me either. I was on 20 days of Vancomycin and it seemed to to do the job.

I resumed my Lyme/Co treatment very cautiously, with small doses of ABX, every other day at first. And I have to delay resuming treatment for Bartonella until we're sure that my gut stays ok. All I can do is wait and see to be sure that the C.Diff stays away.

You did not mention your daughter's age. So I'm unsure whether the following suggestions will apply. If you want to consider any of the following, I'd get clearance from your LLMD before trying.

Saccaharomyces Boullardii is the probiotic strain that is responsible for helping to keep C. Diff in check. This strain is a non-pathogenic type of yeast which stays in the body only while one is consuming it -- it does not permanently reside in the GI tract like many of the other probiotic strains we take. Studies have shown that taking this probiotic strain while undergoing C. Diff treatment resulted in a better treatment outcome.

Many LLMD's recommend that patients take this probiotic strain prophylactically during Lyme treatment to try and keep C.Diff from occurring. One popular brand of this is Florastor.

Florastor does have lactose in it. If your daughter has any lactose intolerance or dairy sensitivities then there are other companies that manufacture this. I use the brand by Pure Encapsulations because it has no lactose in it.

Also, I switched my other probiotics out. I'm now taking VSL #3 in very large quantities. I'm taking the pill form (not the powder form) and I'm taking about 5 capsules of that a day right now while I try to fix my gut. Hopefully soon I can reduce this amount as this is an expensive probiotic.

Another probiotic that my doc wanted me to include is Del-Immune V. It's helped me tremendously as well.

There are other products which can be used to help heal the gastro tract. Doc has me taking them as well. C. Diff really can wreak havoc and I found I needed to try and heal my innards. If you'd like to know about those products, just let me know and I'd be happy to share.

C. Diff for me was very frightening. It was alarming how quickly a patient can deteriorate. This last episode I had came on seemingly quickly and I deteriorated quickly in a matter of hours.

Once we've had a C. Diff episode, we can be more prone to future episodes. So it's a good idea to be vigilant and try and do what you can to protect the gut, especially while undergoing ABX treatment of any kind.

Hope this helps!

Fuzzy

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Connieaag
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Thanks Fuzzy! She is 15, almost 16. She was taking Florajen while on Abx and just switched to Ortho Biotic which has 2 billion CFU saccharomyces boulardii per her compounding pharmacist. She actually was on that before taking Flagyl. She didn't tolerate Flagyl in the Lyme Abx course and could not get beyond 1/2 pill a day. For the C-Diff she had no problem with 3 tabs a day but it didn't help the diarreha! Go figure!

I'm trying to figure out if she needs to stay on the Xifaxan 200mg 3x a day or if she can take one a day and others have indicated.

Do you know?

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FuzzySlippers
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I'm not sure I understand. Are you asking if she should take one a day of the Xifaxan? If so, I'd run it past the doc. I've never tried the Xifaxan.

I know sometimes with C.Diff treatment with Vancomycin the doctors will slowly pulse the withdrawal of the treatment. I'm not sure of the timing as that was not done with me this go-round. I also don't know whether the pulsing/withdrawal method (i.e., slowly stopping the C.Diff treatment on a graduated basis) is used with Xifaxan.

When my C.Diff recurred and I deteriorated so quickly at the end of September, my doc actually had to place me on Immodium for a few days as I began treatment. My case at that time was kind of severe.

Another thing that is recommended due to the profuse loss of water in the body with this is to do all you can to stay hydrated. Drinking water with added electrolytes (or even Gatorade if tolerated) is really, really helpful.

Fuzzy

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Connieaag
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She was on Immodium too. She also had 3 fluid IV bags on three seperate occassions. We're about to that point again I think. Not fun.

I will have to ask about pulsing Xifaxan. So far after 3 doses it isn't working this round

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FuzzySlippers
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Yep, I had to get IV hydration too.

I'd put a call in to the prescribing doc on the Xifaxan and see what can be done. There is always Vancomycin. It's worked for me.

Also, I'm sure you already know this .... but...just in case you hadn't known, be sure that the probiotics are being taken at least 2 hours away from the antibiotic dose.

Normally it doesn't matter when we take the saccharomyces boullardi because it's a type of yeast and antibiotics don't kill yeasts. But since your saccharomyces is included in your regular probiotic (which has healthy bacterial strains which can be killed by antibiotics), then you need to take the Ortho Biotic 2 hours away from the antibiotic.

Not an easy thing to do when one is taking antibiotics 3-4 times a day, I know!

Just another thing I thought I'd offer, is that with the C. Difficile I found through trial and error and also stool testing that I personally needed much higher counts of probiotics than normal. Most probiotics yield about 20-30 billions CFU's per dose. That was not enough for me as sick as my GI tract was/is.

That's why I had to make the change to VSL #3 probiotics. One dose of that yields 450 billion cfu's! This brand does not include saccharomyces boullardii and so the saccharo needs to be got through an additional product. The VSL #3 has published studies (see, PubMed, if you are interested) regarding it's efficacy is treating and controlling difficult intestinal conditions like IBS, ulcerative colitis, crohn's disease.

I wonder whether the 2 billion CFU's of saccharo that is in your Ortho Biotic is the same amount that the research has indicated is needed to treat C.Diff? I just don't know. I know that for treating active C.Diff, doctors (and also the makers of Florastor) recommend taking 1,000 mg of saccharo a day. That would be 4 capsules a day. Usually 2 in the am and 2 in the pm.

I just don't know how the units of measurement of CFU's vs. mg compare.

Hope this doesn't confuse things.

Fuzzy

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