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Treatment of clostridium difficile

Question from Kathy

Please provide information on advanced treatment and/or experts on the treatment of clostridium difficile. I have been on Flagyl, and now Vancomycin twice. It has not been a relapse at anytime. The drugs control but do not eliminate. As soon as I stop the drug it comes back…no time lag. I have read many articles and have cleaned the bathroom thoroughly to eliminate “spores”. I am 45 years old, and not hospitalized. I have no diseases. I got the c-diff from taking antibiotics this year.

Dear Kathy:

Clostridium Difficile diarrhea recurs in about 10-20% of cases and can be quite difficult to eliminate as you have noted. This is usually due to the failure to kill all the spores in the GI tract. Some physicians suggest avoiding treatment of “mild” relapses, as they will often resolve in several weeks. This may reduce the chance of developing antibiotic resistance.

One way of increasing the chance of eliminating this pesky bug when repeated episodes occur, is to treat with Vancomycin for an extended period of time-and slowly taper(decrease the dosage) gradually. Four-6 weeks is a reasonable time period-using full strength for most of that time. It’s expensive but often works. Sometimes longer duration is needed.

Other methods have included the use of Rifampin (an antibiotic) or the addition of Cholestyramine (which binds the toxin), and lastly-the use of a yeast product known as Saccharomyces boulardi (which allows the normal bacterial flora to replace the C. Difficile-this is still experimental). You may wish to discuss these alternatives with your physician.

Lastly, in some patients eradication is not only difficult-but impossible. It may be valuable to test other family members or close acquaintances who may be asymptomatic-yet harboring the bacteria and passing it on.

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