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Haven been on clindamycin 300mg every 8 hours since Mon or Tues. for dental infection. Diahrrea started yesterday. Hate to be graphic but it just pours out and the smell is pretty strong. Yuck. Have been on hydrocodone and ibuprofen for pain which is now under control. Stomach is knawing (very sore and painful at center of ribcage..probably esophagus?) and stomach is gurgling. Lot of BAD acid reflux. I think that is because of the all the pain meds and ibuprofen though. I've stopped those since pain is gone. (Would the abx cause that as well?) Hope I didn't eat up the lining in my stomach from taking it. It hurts. More concerned though about the diahrrea and possibility of Cdiff. Have taken 4 tablets of immodium and it helped a little and then started up again this early am. LymeToo emailed me info on a supplement to get a health food store today. I'm doing it. I've read up on Cdiff online this am. I guess the best thing to do is get a doc to test me for it. I have no cramping. From what I've read wshing hands completely and sanitizing areas very important. If anyone has dealt with this I'd really appreciate your feedback. Thanks, ~ db
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WildCondor
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Clindamycin is the # 1 offender for c.diff. Stop taking the immodium! You need to get those toxins OUT of the colon, not keep them in there! Keep yourself hydrated. You probably do haqve c.diff, just based on the fact that you took Clindamycin alone.
Here is some info on what to do.
#1 Stay hydrated!
#2 Stop taking any antibiotic that is NOT Vancomycin or Flagyl.
#3 Antibiotics for c.diff , either Flagyl or oral Vancomycin treat c.diff. Make sure you take them lomg enough until the diarrhea stops you feel well and make sure that if you have ANY relapse after you finish them that you do another course.
#4 Florastor (s.boulardii) extremely important to take when you have c.diff and you should have been taking it for prevention. Anytime any of you take an antibiotic for Lyme or other reason, Florastor is essential to prevent c.diff. It works by crowding out the c.diff in the colon with a beneficial yeast. (Do not take Nystatin or Diflucan when you take Florastor or it will just destroy the Florastor because it is a fungus) Do not trust health food store brands as they are not tested for potency like Florastor is. Regular s.boulardii may or may not be totally useless.
#5 Get 3 tests for c.diff by stool sample. Make sure they are diarrhea and that it gets to the lab ON ICE within 2 hours. If you are already on Flagyl or Vancomycin the test may be a false negative.
#6 CLEAN! Everything you touch..with bleach...c.diff is contagious...use your own bathroom if possible and meticulously clean everything.
#7 Probiotics Take as much VSL #3, Theralac, Ultraflora etc. and yogurt as you can!!
If you develop a high fever, chills, vomiting or any extreme pain in the stomach/colon, go to the ER. Don't wait! C.diff can perforate your colon and cause sepsis and death. I do not mean to scare you but you need to be aware of how serious this is.
You are most likely going to need a 3-4 week course of FLagyl, and FLorastor followed by some cholestryramine and probiotics. You likely will not be able to take any other antibiotics for a long time. Got to heal that GI system, your GI flora is very, very disturbed. Here is some further info.
By Prof. Thomas Borody MD PhD FRACP FACG FACP (with references/credits at the end of the article)
Human infection with Clostridium difficile (CD) can take many forms. Those reading this section are probably interested in this topic because they, or perhaps a friend, may be suffering with the more severe effects of CD infection. However, there is a whole spectrum of CD infections ranging from mild forms through to life threatening clinical CD infections (1,14,25,31). These will now be described.
CD infection can exist in patients who can be clinically relatively well - eg carriers of very mildly pathogenic bacteria. Some may have recurrent mild to moderate diarrhea resembling Irritable Bowel Syndrome (IBS) and may not be at all concerned with these symptoms. In fact they may consider themselves to be perhaps part of the normal spectrum of bowel behavior. Still others may have recurrent bouts of severe cramps, diarrhea with or without `wind' and other symptoms. Unless CD is diagnosed and causes these symptoms such patients could well be labeled with a diagnosis of IBS.
Still other patients may have a condition indistinguishable from colitis, with cramps, diarrhea, urgency, mucus and variable amounts of blood (33). At sigmoidoscopy typical inflammation is seen and may initially be diagnosed as `idiopathic' colitis (colitis of unknown cause).
This disorder can also be recurrent with red patches visible on colonoscopy in some areas of the bowel or indeed throughout the colon. This kind of colitis can respond to prednisone, Asacol (and other forms of mesalazine) and other anti-colitis drugs because the steroids and anti-inflammatory drugs non-specifically inhibit many types of inflammation.
Furthermore, drugs such as Asacol (5-ASA compounds - see below) have their own anti-CD activity. They are antibiotics which also possess anti-inflammatory action. Lastly the most severe and often devastating CD infection can develop into `pseudomembranous enterocolitis' with a specific type of inflammation visible at colonoscopy. It may lead to fulminant colitis, megacolon and even to death from colon perforation and peritonitis. These latter conditions are generally uncommon (35). However, in recent years we have seen the arrival in North America of a mutant CD bacterium with markedly elevated levels of toxin production. This new strain has a tendency to result in the more severe clinical conditions described above and can more frequently cause pseudomembranous enterocolitis, megacolon and perforation (36). Chronic CD infection is estimated to occur in perhaps 15-30% of those infected. In some, re-infection can occur with same or different strain. Also, the small bowel may act as reservoir of spores, entering the colon and there is recent evidence that the appendix may also act as a reservoir of C. difficile. (37). Risk factors for relapse are said to include :- the number of previous episodes, the need to use antibiotics recurrently, female sex, use of stomach acid suppressants, and older age groups. (3,34)
C difficile is acquired from contact with humans or objects harboring these bacteria. It can be commonly acquired during hospitalization with up to 30% of those who have spent a prolonged period in hospital leaving the hospital carrying these bacteria in the bowel flora. (12,13) This is particularly so if antibiotics had been administered so disturbing the protection of the natural bowel flora. Non-hospital acquisition of CD is occurring more frequently and again a course of antibiotics may permit the growth of CD and `awake' a clinical condition. Human infection occurs through ingestion (via the mouth) and if the bacterium survives acid and bile on its passage into the bowel it may be eradicated by the normal bowel flora. However, if the bowel flora is suppressed because of concomitant use of antibiotics, CD can colonize the flora and remain with the patient - generally for life. In some individuals it seems that antibiotics are not required for colonization to take place. This may be perhaps due to inadequate defense of the naturally occurring flora within the bowel. CD is a very hardy organism probably because it contains spores. Spores are unable to be eradicated by any currently known antibiotic. One way of eradicating spores is to autoclave the spore-containing specimen using a sterilizer. Of course a patient cannot be placed in a sterilizer. However some natural bacteria appear to be capable of inhibiting the growth of CD and even eradicating the spores and this characteristic has been used to develop `bacteriotherapy' which will be described below. There are a number of therapies for C difficile-associated disorders:
a. Withdrawal of antibiotics In many situations when antibiotics are stopped the normal flora re-grows and the patient can actually lose the presence of the CD and its toxins. In this situation the normal indigenous flora has not been damaged enough by the antibiotics to lose its protective bacteria, especially Bacteroides, the friendly Clostridia species and other bacteria which are antagonistic to CD. This may be the mechanism by which many recover spontaneously and indeed lose the CD. However, in many situations even withdrawal of antibiotics does not lead to the disappearance of CD which then may persist lifelong.
b. Metronidazole(Flagyl) This is a first-line medication for treatment of CD infection but on its own it is unlikely to eradicate CD and can cause nausea in higher doses. From clinical experience it appears that if the bowel flora is adequate then metronidazole together with the existing bowel flora may at least terminate the clinical infection. (4,5,6)
c. Vancomycin Equally powerful if not a better though more expensive anti-microbial agent. Vancomycin's advantage is that it is not absorbed into the blood stream and very rarely causes side effects. Some specialists prefer a combination of metronidazole and vancomycin. Whereas metronidazole has some theoretical problems such as peripheral nerve damage with long term usage vancomycin does not have significant complications when used orally long term. (4,5,7)
d. Rifampicin Yet another anti-Clostridial antibiotic which has been found to be useful in CD infection and can be used for longer periods but may have side effects. We know it can be used for 1-2 years continuously since rifampicin was part of the standard drug for treatment in tuberculosis giving us safety experience with long-term usage.
e. Teichoplanin This is a newer glycopeptide antibiotic related to vancomycin and is not readily available. It has probably little advantage over vancomycin unless resistance has developed and resistance is said to be rare. (5,7)
f. Rifaxamin Rifaximin is quickly becoming yet another useful medication in the treatment of C difficile and like vancomycin is not absorbed from the bowel. It is similar in its action to vancomycin, has high in-vitro activity against C difficile and achieves high faecal concentrations after oral administration. It can be also successful in those patients who had failed metronidazole and vancomycin as well as combinations of vancomycin and rifampicin. (38,39,40)
g. Nitazoxanide Yet another antimicrobial agent added to our armory of fighting C. difficile is Nitazoxanide. Also used in treatment of parasites, nitazoxanide has in-vivo and in-vitro activity against C. difficile and had recently been reported to be not only useful orally in recurrent C. difficile but also in combination as an oral preparation combined with vancomycin enemas. (42) With antibiotics as a group various methods such as `pulsing', combinations, tapering and combination with probiotics (beneficial bacteria) - listed below - have been advocated by some - and indeed useful in some individuals. Such combinations should not be discarded as `anecdotal' and we should collect reports from individual successes and cures, for in this way we may be able to design trials and test better treatments. (9,10,25,26)
h. Cholestyramine(Questran) and Colestid granules These are adsorbing agents to which CD toxins may attach so as not to cause diarrhea and cramping. They do not eradicate CD but can reduce the effects of the toxins. The powders can be difficult to mix with fluids and may cause nausea. Helpful clinically to many, and also lower cholesterol as a beneficial `side effect'. (8)
i. Antagonistic bacteria - Lactobacillus GG (Culturelle - in the US) This lactobacillus is a probiotic which was isolated by Drs Sherwood Gorbach and Barry Goldin (hence LGG) is available in many countries for treatment of chronic CD infection symptoms. On its own LGG may suppress CD. When combined with or preceded by vancomycin and metronidazole it may be curative in some situations. In our experience it is probably required in high doses and for longer periods of time. The major advantage of LGG is its lack of side effects and potential for cure in some patients. (11,15,27)
j. Steroids Intravenous steroids have been used in refractory C. difficile colitis in patients who are very ill and are not responding to metronidazole and vancomycin.
k. Mesalazine Mesalazine belongs to a group of medicines used in colitis called 5-Amino Salicylic Acid. This group includes azulfidine, mesalazine and olsalazine. Mesalazine has anti-inflammatory actions in colitis, but more importantly in CD it is an antibiotic (Lin and Pimentel, US Patent 6,326,364-2001 ) which can retard the growth of CD and in chronic CD infection can abolish the symptoms when taken continuously at doses used in colitis. It is also much cheaper than is vancomycin and has few side effects.
l. Saccharomyces boulardii This is a friendly fungus which has activity against the C. difficile toxins A and B. It colonizes the bowel transiently, has been proven to give relief better than placebo but has never been able to eradicate CD. It is useful especially in combinations to control symptoms initially. (2,16,28)
m. Clostridium butyricum (Myiari 588 Strain) This is a friendly Clostridium which can live normally in the human flora, is quite safe and is available commercially in Japan, Korea and China. It interferes with the growth of CD antagonizing its multiplication. It is commonly used in Japanese hospitals to successfully prevent CD being acquired and is given to patients on admission to hospital. Little western literature is available on this probiotic.
n. Immune Anti-C difficile Globulin This is normal pooled human gammaglobulin which generally contains antibodies to C difficile toxins and can be used in severe cases. Generally not curative. (29,30,32)
o. Surgery In severe cases of fulminant colitis or toxic megacolon removal of the colon may be required, otherwise perforation, septic shock and death may follow. Even surgery in these very severe cases may be too late to save lives.
p. Restoration of Human Bowel Flora Two methods have been used. Infusion into the bowel of freshly cultured mix of bowel bacteria, or infusion of filtered, complete, healthy human fecal bacteria. The first form has been reported by Tvede et al in 1989 but is no longer available. A two-bacterial per-enteroscope infusion has been available in Kansas City for years and has been of considerable help to many patients. It uses Bacteroides bacteria (the most common bacterium in the bowel) plus healthy or beneficial E.coli as two antagonistic bacteria to CD. It can rid the patient of CD and spores. Success rate is not known. (21) The other method is the infusion of all the bacteria originating from a healthy donor. This is now the recommended therapy for recurrent and refractory C. difficile infection in North America. (42) It is the therapy of last resort for severe C. difficile infection where other therapies are failing and the patient continues to have marked symptoms. Practicing physicians should be aware that patients now have the option of total bowel flora infusion which may in some situations be a life-saving procedure. This is the recommended therapy for relapsing, severe CD infection where other therapies are failing and the patient continues to have marked symptoms. The treatment uses bowel flora (faeces) homogenized in sterile saline, often filtered, and the slurry containing the total living protective bacteria is infused into the bowel of the patient. This can be done through a colonoscope under sedation, via enema, or through a naso-jejunal tube to take care of the small bowel reservoir of CD. Though perhaps aesthetically not very attractive this therapy is the most reliable method available to kill the CD and its spores. Summing up all published series and anecdotal reports the therapy has a documented cure rate of well over 80%. (17,18,19,20,22,23,24) It is carried out on a routine basis as a clinical service in Sydney, Australia for patients with documented, chronic CD infection with a success rate in CD eradication of > 90%.Sites in North America are now becoming available.
REFERENCES:
1. Cleary RK. Clostridium difficile-associated diarrhoea and colitis: Clinical manifestations, diagnosis and treatment. Dis Colon Rectum 1998;41:1435-1449. 2. Surawicz CM, McFarland LV, Elmer G. Chinn J. Treatment of recurrent Clostridium difficile colitis with vancomycin and Saccharomyces boulardii. Am J Gastroenterol. 1989;84:1285-1287. 3. Fekety R, McFarland LV, Elmer G, Chinn J. Recurrent Clostridium difficile diarrhoea: characteristics of and risk factors for patients enrolled in a prospective, randomised, double-blinded trial. Clin Infect Dis. 1997:24:324-333. 4. Teasley DG, Gerding DN, Olson MM et al. Prospective randomised trial of metronidazole versus vancomycin for Clostridium difficile-associated diarrhoea and colitis. Lancet. 1983;2:1043-1046. 5. Wenisch C, Parschalk B, Hasenhundt M, Hirschl AM, Graninger W. Comparison of vancomycin, teichoplanin, metronidazole, and fusidic acid for the treatment of Clostridium difficile-associated diarrhoea. Clin Infect Dis. 1996;22:813-818. 6. ASHP therapeutic position statement on the preferential use of metronidazole for the treatment of Clostridium difficile-associated disease. Am J Health Syst Pharm 1998;55:1407-1411. 7. De Lalla F, Nicolin R, Rinaldi E et al. Prospective study of oral teichoplanin versus oral vancomycin for therapy of pseudomembranous colitis and Clostridium difficile-associated diarrhoea. Antimicrob Agents Chemother.1992;36:2192-2196. 8. Ariano RE, Zhanal GG, Harding GK. The role of anion-exchange resins in the treatment of antibiotic-associated pseudomembranous colitis. CMAJ. 1990;142:1049-1051. 9. Tedesco F. Treatment of recurrent antibiotic-associated pseudomembranous colitis. Am. J Gastroenterol. 1982;77:220-221 10. Tedesco FJ, Gordon D, Fortson WC. Approach to patients with multiple relapses of antibiotic-associated pseudomembranous colits. Am J Gasteroenterol 1985;80:867-868 11. Lewis SJ, Freeman AR. Review article: the use of biotherapeutic agents in the prevention and treatment of gastroenterological disease. Aliment Pharmacol Ther.1998;12:807-822. 12. Fekety R, Kim KH, Brown D, Batts DH, Cudmore M, Silva J Jr. Epidemiology of antibiotic-associated colitis: isolation of Clostridium difficile from the hospital environment. Am J Med. 1981;70:906-908. 13. Kim KH, Fekety R, Batts DH et al. Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J infect Dis. 1981;143:42-50. 14. Kelly CP, Pothoulakis C, LaMont J. Clostridium difficile colitis. New Eng J. Med 1994;330:257-262. 15. Seal D, Borriello SP, Barclay, Welch A, Piper M, Bonnycastle M. Treatment of relapsing Clostridium difficile diarrhoea by administration of a non-toxigenic strain. Eur J Clin Microbiol 1987;6:51-53. 16. Surawicz CM, McFarland LV, Elmer G, Chinn J. Treatment of recurrent Clostridium difficile colitis with vancomycin and Saccharomyces boulardii. Am J Gastroenterol 1989;84:1285-1287 17. Persky SE, Brandt LJ. Treatment of recurrent Clostridium difficile-associated diarrhoea by administration of donated stool directly through a colonoscope. Am J Gastroenterol 2000;95:3283-5. 18. Eisman B, Silen W, Bascom GS, Kauver AJ. Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery 1958;44:854-9. 19. Bowden TA, Mansberger AR, Lykins LE. Pseudomembranous enterocolitis: Mechanism of restoring flora homeostasis. Am Surg 1981:47:178-83. 20. Schwan A, Sjolin S, Trottestam U. Relapsing Clostridium difficile enterocolitis cured by rectal infusion of homologous faeces. Lancet 1983;ii:845 21. Tvede M, Rask-Madsen J. Bacteriotherapy for chronic relapsing Clostridium difficile diarrhoea in six patients. Lancet 1989;i:1156-60. 22. Flotterod O, Hopen G. Refractory Clostridium difficile infection. Untraditional treatment of antibiotic-induced colitis. Tidsskr Nor Laegeforen 1991;111:1364-5. 23. Paterson DL, Irdell J, Whitby M. Putting back the bugs: Bacterial treatment relieves chronic diarrhoea. Med J Aust 1994;160:232-3. 24. Lund-Tonnesen S, Berstad A, Schreiner A, et al. The effect of faecal enema on five microflora-associated characteristics in patients with antibiotic-associated diarrhoea. Scand J Gastroenterol 1999;34:580-6. 25. Kelly CP, Pothoulakis C, Lamont JT. Clostridium difficile colitis. N Engl J M 330:257-262. 26. Tedesco FJ, Gordon D, Fortson WC. Approach to patients with multiple relapses with antibiotic-associated pseudomembranous colitis. Am J Gastroenterol 1985;80:867. 27. Gorbach SL, Chang TW, Goldin B. Successful treatment of relapsing Clostridium difficile colitis with Lactobacillus GG. Lancet 1987;2:1519. 28. McFarland LV, Surawicz CM, Greenberg RN, Fekety R, Elmer GW, Moyer K. Randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA 1994;271: 1918. 29. Kyne L, Warndy M, Qamar A, Kelly CP. Asymptomatic carriage of Clostridum difficile and serum levels of IgG antibody against toxin A.N Engl J Med 20;342:390-397. 30. Leung DY, Kelly CP, Boguniewicz M, Pothoulakis C, Lamont JT, Flores A. T with intravenously administered gamma globulin of chronic relapsing colitis induced by Clostridium difficile toxin. J. Paediatr 1991;118:633-637. 31. Kyne L, Kelly CP. Recurrent Clostridium difficile diarrhoea. Gut 2001;49:152-153. 32. Leung DY, Kelly CP, Boguniewicz M et al. Treatment with intravenously administered gamma-globulin of chronic relapsing colitis induced by Clostridium difficile toxin. J Pediatr 1991; 118:633-7. 33. Saad Fadi Yassan, Tonia M. Young-Fadok, Nizar N Zein, Darrell S Pardi. Clostridium difficile-associated diarrhoea and colitis. Mayo Clinic Proc.2001;76:725-730. 34. McFarland L. Surawicz CM, Stamm WE. Risk factors for Clostridium difficile carriage and C difficile-associated diarrhoea in a cohort of hospitalized patients. J Infectious Dis 1990;162:678-684. 35. Bartlett JG. Clostridium difficile: clinical considerations. Rev Infec Dis.1990;12(suppl 2):S243-S251. 36. Riley TV. Epidemic Clostridium difficile. MJA 2006;185:133-134. 37. Mahajan LA, Hupertz V, Mahajan S, Lisa F, John D. The Appendix: A possible reservoir for Clostridium difficile. Am J. Gast. 2006:101:S392. 38. Johnson S, Galang M, Schriever C, Kelly C, Gerding D. Rifaximin chaser following standard therapeutic cocktail for breaking the cycle of multiple C. difficile diarrhea recurrences. Am J. Gast. 2006:101:S219. 39. Rubin DT, Sohi S, Gluthar M, Thomas T, Yadron N, Surma BL. Rifaximin is effective and safe for the treatment of Clostridium difficile-associated diarrhea. Am J. Gast. 2006:101:S208. 40. Berenbaum PL. Oral rifaximin in treatment of Clostridium difficile-associated diarrhea. Am J. Gast. 2006:101:S199. 41. Korenfield S, Desai K, Gotian A, Brandt LJ. Vancomycin enemas and nitazoxanide treatment of recurrent C. difficile colitis. Am J. Gast. 2006:101:S322. 42. Borody TJ, Leis S, Pang G, Wettstein AR. Fecal bacteriotherapy in the treatment of recurrent C. difficile infection. (Up-To-Date) (http://patients.uptodate.com/topic.asp?file=gi_dis/32751
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ONE TOUGH BUG
by WildCondor
How many of you read the drug information sheet that comes with your antibiotic prescription? If you have, you'll notice that every antibiotic comes with a warning label that reads something like this. ``Pseudomembranous colitis has been reported with the use of nearly all antimicrobial agents, including this antibiotic, and may range in severity from mild diarrhea to potentially life threatening colitis.''
In laymen's terms, pseudomembranous colitis is the most serious form of Clostridium difficile (C.difficile) infection. Named because it is so difficult to culture, Clostridium difficile is also becoming increasingly difficult to treat.
As if having Lyme disease and multiple co-infections to battle weren't enough for my body to handle, I had the unfortunate displeasure of experiencing C.difficile up close and personal. It began for me on Christmas day 4 years ago, during my antibiotic treatment.
First came the stomach cramps, which left me slouched over the porcelain throne, crying like a baby. Next came unrelenting diarrhea and nausea so overwhelming I couldn't leave the bathroom. The cramping pain was so intense I was drenched in cold sweats, cuddled in a fetal position on the bathroom floor. When I developed a fever of 104 degrees, my family took me to the Emergency room. The doctor I saw said I had the stomach flu, and sent me home and rest.
After 2 weeks of constant fever, and unrelenting bloody diarrhea, I collapsed from dehydration and woke up in the hospital ER. I begged one of the nurses to put me to sleep because the pain in my abdomen was so severe. After some fluids, painkillers and antidiarrhea medication, I was back home in my bathroom again, with no answers, and still suffering.
It took another week, and 2 more doctors' visits to get a stool test order. Finally, after seeing a Gastroenterologist (GI), I was diagnosed with C.difficile colitis. My GI then explained to me all about intestinal flora, and how mine had been disturbed by taking antibiotics.
My GI explained that our intestinal tract contains hundreds of types of bacteria. Most bacteria are friendly, and help our immune system to function properly. The good bacteria play a vital role in suppressing the growth of harmful organisms. When you take an antibiotic for an infection, the friendly bacteria are killed off along with the bad bacteria that are causing your sickness. When the friendly bacteria are destroyed, dangerous bacteria, like C. difficile can quickly grow out of control.
It's very easy to become infected with C. difficile because it produces spores that can survive in many environments. C.difficile spores can be found anywhere people go, and are very contagious. The most common places to find C.difficile spores are hospitals, nursing homes, schools, furniture, bed rails, door knobs, linens, and any private or public bathroom. This is why hygiene and proper daily sanitation are so important. Everywhere you go, always wash your hands!
Not everyone who comes in contact with C.difficile spores becomes symptomatic. As in the case of numerous other infectious agents, C.difficile carriers are present in the general population. In my research, I have noted that it generally takes the combination of the ingestion of a C. difficile spore, plus a disruption of intestinal flora by antibiotics to develop a full blown infection. C. difficile spores will usually lie dormant inside the colon until you take an antibiotic. However, there have been cases where patients have developed Pseudomembranous colitis without having taken antibiotics.
The true nature of the beast, C. difficile produces two known toxins that inflame and damage the lining of the intestines. The toxins destroy the normal colon cells and produce pseudomembranes, which are visualized on colonoscopy as yellowish-white plaques of inflammatory cells on the interior surface of the colon. The hallmark symptom of C. difficile colitis is mild to severe watery diarrhea, although you can have C.difficile without severe diarrhea in milder cases. Other symptoms include fever, abdominal cramps, nausea and weight loss. Severe diarrhea can lead to dehydration, and electrolyte imbalances.
In severe cases, C.difficile can lead to life threatening complications such as toxic megacolon, peritonitis (inflammation of the lining of the abdominal cavity), perforation of the colon, sepsis, and death. Stool testing is the most widely used test for diagnosing C. difficile colitis. There are two different toxins, toxin A and toxin B, both capable of causing severe infection. In my experience, I found an alarming number of hospitals and laboratories only test for toxin A, when in fact, patients can be ill with toxin B, as I was.
It is also important to do 3 stool tests from 3 separate bowel movements in order to ensure accuracy. The testing for C.difficile toxins is far from perfect, as false negative tests can occur. Often a colonoscopy is necessary to look for the pseudomembranes on the inside of the large intestine.
Antibiotic associated diarrhea can occur within days of completing a round of antibiotics, or up to several months later. Therefore, if you have new symptoms of diarrhea, it is important that you see your doctor. Most antibiotics can cause diarrhea, so it can be difficult to distinguish the symptoms of this common drug side effect with the symptoms of C.difficile. If your symptoms persist, it is always a good idea to do the stool testing to make sure.
Ironically, the treatment for C.difficile is more antibiotics! In patients with mild colitis, stopping the antibiotic that caused the infection may be enough to cause the colitis and diarrhea to subside. There are only two drugs, Flagyl�/metronidazole), and vancomycin that treat the infection. A typical first-time course of treatment is 2 weeks of either medication. Relapse rates for C.difficile are extremely high. Because C.difficile forms spores which are very difficult to eradicate, and the infection often persists despite adequate treatment. It can take multiple courses of Flagyl� or vancomycin to eradicate the infection.
Relapses can occur even a day or so after stopping treatment. The surviving spores can hatch, multiply and produce toxins again, and again. It is a vicious cycle, and one that is tough to break. Relapses of C.difficile can require many months of Flagyl� or oral vancomycin therapy. Many GI doctors are now experimenting with a newer drug Xifaxan� for relapsing C.difficile.
Because of the resilience of this germ, physicians are experimenting with pulse dose antibiotic therapy. Pulse dose therapy involves treating the patient for several days with antibiotics, followed by several days of no medication. The idea is that by stopping and starting antibiotic therapy, the C.difficile spores hatch, and are then killed by the next pulse of antibiotics. Physicians also use long, tapering courses of vancomycin, where the doses are gradually reduced over several months.
Doctors are struggling to find new ways to treat this stubborn bacterium. It has been labeled as a ``super bug,'' and has reached epidemic proportions in some areas. In Quebec, Canada, an outbreak of C.difficile killed over 200 patients last year. The outbreak in Quebec was the start of a new, virulent strain of C. difficile that produces large amounts of both toxins A and B. The epidemic strain produces more severe symptoms than the common strains, and has a much higher mortality rate. In addition, the currently available diagnostic tests cannot distinguish the new strain from the older strains.
Some physicians use cholestyramine (Questran�) to help remove the toxins caused by C. difficile. Cholestyramine, typically used for reducing cholesterol levels, binds bile acids and other substances in the intestine. It is thought that by binding the toxins produced by C. difficile, they will be removed faster from the intestine, causing less damage.
Cholestyramine can be difficult to tolerate because it can bind to the antibiotics, pulling them out of the body, thus weakening the treatment protocol. For this reason, cholestyramine is usually used following a course of Flagyl� or vancomycin. In addition, proper supplementation of beneficial intestinal ``good'' bacteria is essential. Patients must try to restore the balance of intestinal flora. This is why it is so important to take probiotics such as lactobacillus acidophilus, lactobacillus bifidus, and saccharomyces boulardii both during, and after antibiotic therapy. It is also essential that you replenish your ``good'' bacteria by using the highest quality probiotic you can find.
It is important to avoid antidiarrheal medications such as Imodium�, since diarrhea is the body's way of removing the toxins from the colon. If you take antidiarrheal medications, the toxins remain in the colon for prolonged periods of time, and make the infection worse. Most patients have to stick to a very bland diet, and stay very well hydrated during acute illness.
According to Dr. Kelly Karpa, author of ``Bacteria for Breakfast,'' in order to obtain the best results from probiotics, supplements are often necessary. Dr. Karpa explains on her website, bacteriaforbreakfast.com, that ``...studies have repeatedly shown that probiotic products from different manufacturers vary tremendously. Some products don't contain any where near the numbers of live microorganisms that they claim to possess.
As consumers, you don't want to waste your money on a product that contains few (if any) live bacteria when you purchase it. Likewise, you don't want to purchase a product that doesn't possess a strain of bacteria that has truly been found to be safe and effective.'' Dr. Karpa goes on to explain the importance of probiotic supplementation both during and after any antibiotic therapy.
In my experience, I found the best probiotics to take should have high numbers (billions of living organisms) per dose. After I completed my antibiotic treatment for C.difficile, the products which helped me most were Theralac�, Florastor�, and VSL #3�. Theralac� is one of the highest quality probiotics available. With 20 billion CFU (colony forming units) per capsule, Theralac� helps reduce bloating, gas, heartburn, poor digestion, constipation and diarrhea, safely and effectively. Florastor�, in particular, has been useful in treating C.difficile because it is beneficial yeast (saccharomyces boulardii) which can inhibit the replication of C.difficile, and out compete it for space inside the colon. VSL # 3� contains 450 billion live bacteria per dose, and can be a great help to anybody on antibiotic therapy.
It is important to remember that what you ingest daily probiotic wise is what you have in your intestines. Most probiotics do not multiply inside of you. Any time you require antibiotics, daily supplementation with a high quality probiotic such as Theralac�, and choosing foods with active cultures in them such as yogurt, are essential to prevent C.difficile.
During my bout with C.difficile, I found it alarming at how easy it is to be misdiagnosed with Irritable Bowel Syndrome (IBS), or the stomach flu, when a potentially life-threatening bacterium was eating away at my insides. These ``super bugs'' are becoming more common and dangerous. It can be very frightening situation if you get a serious bacterial infection requiring antibiotics, when you have chronic C.difficile infection. Imagine the challenge of treating a chronic Lyme disease patient, with chronic relapsing C.difficile. You cannot take antibiotics, so you are stuck between a rock and a hard place.
Luckily, there is a treatment of last resort for relapsing C.difficile, it is called fecal bacteriotherapy. This involves infusions of antibodies, by using fecal enemas from a healthy donor. Feces from non-infected donors are made into a suspension and administered as enemas to the patient. The normal bacteria from the donor's stool displace the C. difficile, and cure the patient. It may sound disgusting, but it can be a lifesaving treatment for people suffering from life threatening C.difficile colitis.
I was very fortunate to have been able to overcome C.difficile thanks to an excellent GI doctor, and modifications to my diet and lifestyle. Although the threat of ``super bugs'' and horrifying infections is very real, the human body has an amazing ability to heal. Remember that treatment for serious infections such as Lyme disease require long term antibiotic use.
The mistake most people make is when they insist on a prescription for antibiotics for a common cold. Antibiotics are necessary and life-saving medicine, with tremendous value. Using antibiotics without an accurate diagnosis should be discouraged. However, the benefits of properly prescribed antibiotics for legitimate reasons usually far outweigh the risk of developing C. difficile. Remember to read those warning labels, and always take your probiotics!
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