If you have been diagnosed with C. diff infection then you will be naturally very worried as this infection can be extremely dangerous. It is one of the leading causes of morbidity (ill health) and mortality amongst the elderly hospitalized population. Read on to find information about the latest treatments and how to beat this horrible infection.
When talking about antibiotics and C. diff infection it can seem confusing because you may have heard that people who are taking antibiotics or have recently finished a course are more at risk of infection with C. diff and yet the first line of treatment is normally antibiotics.
There are many different types of antibiotics and some of them put you at risk if you come into contact with C. diff bacteria or spores. They do this because they are broad spectrum antibiotics. Instead of being narrowly targeted they will kill off lots of bacteria including the friendly or normal flora which live in your bowel and help to protect you against C. diff. The commonest of these are ampicillin, amoxicillin, clindamycin and cephalosporins.
If you have a mild case of C. diff infection then stopping taking these antibiotics under medical supervision may be enough to allow you to recover. In most cases though special antibiotics will be prescribed to target the C. diff.
There have been studies done to try and see which antibiotics work best against C. diff infection. In many hospitals the first choice of antibiotic has always been metronidazole but are doctors choosing this because it is the best or because it is the cheapest?
Some studies have shown that as the symptoms die back and the stools become firmer the levels of metranidazole in the bowel drop and this could allow the infection to resurface, so some doctors are now recommending that another antibiotic vancomycin should be used. This is more expensive but it has the advantage that the levels in the bowel stay higher and so the infection is less likely to return.
These drugs are initially given orally but this can be a problem if there is vomiting present. Metronidazole can be given intravenously but vancomycin does not work via this route. The treatment is usually given for 10-14 days but may be continued for longer if other antibiotics need to be given to treat another underlying infection.
Another antibiotic called fidaxomicin has been shown to have a lower incidence of recurrence of the infection than either metronidazole or vancomycin, also it has a narrower spectrum and so causes less disruption to the normal microflora in the bowel. It has also been shown to reduce the incidence of re-infection with a different strain of C. diff.
One small study showed that the recurrence of the infection was less likely when vancomycin treatment was followed up with a course of an antibiotic called rifaximin.
Sometimes vancomycin is introduced directly into the bowel. This can be useful and successful when oral antibiotics cannot be tolerated but should be reserved for severe cases as perforation of the colon is a risk. This method should only be attempted by personnel who are very experienced.
There has been some success preventing recurrence using a tapered regime of vancomycin where the dose is gradually reduced over time and also with intermittent or pulsed administration. This involves giving a dose every few days. This allows spores which are dormant in the bowel to turn back into bacteria which can then be killed.
If you have a diagnosis of C. diff infection then it is important to try and beat it first time around because if a relapse does happen it is far more likely that complications will occur.
Your doctor will choose which antibiotic to give you but being aware of what is available and the possible outcomes will allow you to have a conversation about what is the best for your case.
The need for surgery or indeed a fatal outcome is far more likely if a C. diff infection comes back after the initial treatment. It has been found that in some cases when the symptoms return it is not the original infection coming back (although this can happen) but that the patient has been re-infected.
This is more likely to happen in a hospital or care home setting where there can be high levels of C. diff spores in the environment. Spores are dormant but will be re-activated and turn back into bacteria if ingested.
They can live for weeks or months on surfaces such tables, toilets, sinks, floors, beds and windows. It is important to always put down the lid on the toilet before flushing to stop spores from rising up from the toilet and settling on surrounding areas as they can do.
It is vital that the infected person's environment is thoroughly
cleaned on a regular basis with chlorine bleach as this will kill the
spores. Dilute the bleach to one part bleach to ten parts water. Other
cleaners have been found to increase the number of spores! Pay
particular attention to high touch areas like handles. Wash laundry on
the highest temperature possible and use the dishwasher on the highest
It is also important that the infection is not passed from one person to another so hand washing is vital. Alcohol does not kill C.diff so hand sanitizers will not work. Soap and water with plenty of friction is the order of the day.
Concentrate on the areas between the fingers, the finger nails, the thumb, the dip in the palm of the hand and underneath rings (take them off if possible). As a guide for how long to wash your hands, sing Happy Birthday through twice.
If you can prevent re-infection then this will help you beat C. diff infection. If you notice that a good cleaning regime is not being used around your family member then either complain or do it yourself as I did when my sister was infected.
So far we have talked about antibiotic treatments and prevention of re-infection but there are other treatments which can be tried. As C. diff infection is becoming an increasing problem new treatments are being sought out and evaluated as a matter of urgency.
Having a fecal transplant (sometimes called fecal microbiota transplantation or fecal bacteriotherapy) is a treatment which has a higher success rate than antibiotic therapy but it can be difficult to arrange to have this done. In the US the FDA has now approved it as a treatment but only for cases that have failed to respond to antibiotic treatment. Although it is very low tech it can be difficult to find a doctor who is willing to do it.
Basically poop from a healthy donor (screened to exclude the possibility of other diseases) is introduced into the bowel of the person with the C. diff infection. This new poop will contain a wide diversity of normal friendly bacteria which will fight and exclude the C. diff bacteria. These are lacking in the ill person, usually because they have been killed off by broad spectrum antibiotics.
For more information about how to get a fecal transplant and the power of poop see thepowerofpoop.com.
This medication was originally developed to kill parasites. It has seen some success in treating C. diff infection but it is not clear at the moment whether it is better than vancomycin.
These resins interfere with the disease processes by binding to the toxins produced by C. diff and have been used as alternative therapies in CDI. Used alone they can reduce symptoms but in order to effect a cure they are usually used in conjunction with vancomycin. They must be taken a few hours apart from the antibiotic because they also bind to vancomycin. They have the advantage of not interfering with the normal flora in the bowel.
There are ongoing studies on the role of probiotics in the treatment of C. diff infection. They are widely used in Japan as a preventative to stop C. diff taking hold if broad spectrum antibiotic therapy is needed. A particular strain Clostridium butyricum (strain Myiari CBM 588) is used. There has been some success using probiotics in conjunction with antibiotics to treat C. diff but more research is needed.
As a last resort in very severe cases the colon or part of it will be removed. This however is not done lightly and is only done when the patient's life is in danger.
This article has concentrated on the current treatments for C. diff infection but research is ongoing and more treatments may be developed in the future.
Perhaps a more preventative stance should be taken, as they do in Japan? As the members of society who tend to succumb to this dangerous infection are the most venerable, such as the elderly and those with underlying medical conditions, perhaps these people should be given prophylactic probiotics when antibiotic treatments or surgery are needed?
If you, a friend or family member is diagnosed with this infection then ask questions and do research. Do not just accept the first treatment on offer but ask if it is the best one.
For more information about the prevention, symptoms and diagnosis of C. diff infection and the story of how I helped my sister through her difficult encounter with this horrible infection please see here.