Posted in Flagyl on May 5, 2015

A new Phase 2 pilot study shows that giving spores of a non-toxic C. difficile bacteria by mouth is effective in stopping repeated bouts of C. diff virus, a major complication of hospitalization.

While C. diff infections used to final ~ an unpleasant but generally benign complaint with repeated bouts of diarrhea, there has been a remarkable change across the last 10 years of my practice. The infection became more common, patients were commonly more severely ill, and the pest became increasingly difficult to treat. C. diff colitis (bowel turbulence) went from responding to a fleeting course of Flagyl (metronidazole), to requiring added prolonged and very expensive courses of parole Vancomycin, to now being often cross-grained to therapy. I’ve seen patients direct emergency colectomy, surgery to remove the bowel, or casually die.

C. difficile fluorescence - CDC

C. difficile fluorescence – CDC

Epidemiology of C. difficile infections

Most cases of C. diff are associated by healthcare—being hospitalized and receiving diffused-spectrum antibiotics, in particular, as well as in nursing home or clinic patients. About moiety the infections occur in those older than 65, unless they account for 90% of the deaths. Use of proton cross-question inhibitors (e.g. Nexium, Prilosec, Prevacid, or Protonix) in addition predisposes to this infection.
From 2000-2010, hospitalizations beneficial to C. diff doubled, along with emerging. see the verb of a more virulent strain, North American pulsed-province gel electrophoresis type 1 (NAP1, aka BI or 027)), what one. produces more toxins. During that limit, deaths related to C. difficile increased 400%, at that time reaching 29,000 deaths each year in the U.S.

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C. diff, especially the NAP1 strains, don’t cor~ well to oral metronidazole, which is inexpensive. Oral Vancomycin is lavish ($1161 for a 10 day beat), and is often given for 2-3 weeks. If patients falling back, which happens in 25-30% of patients, method of treating is resumed, followed by a in due succession tapering course of that antibiotic. A reinvigorated antibiotic, Fidoxamicin (Optimer Pharmaceuticals), approved in 2011, is very lately sometimes used, but again is prohibitively wasteful to many, at $2800/course. It has the vantageground of not altering the GI vegetable life as much as vancomycin and flagyl grant. More recently, some favor stool transplants, euphemistically known being of the kind which fecal microbiota therapy (FMT), for patients with recurrent infections. While unaesthetic and of limited conversion to an act due to the “ick” constitutive element, FMT is dramatically effective, with a 90% restoration rate. Unfortunately, current recommendations are that the stool donor be tested for a multiformity of infectious diseases at a cost of $1500-2000. There might exist a week’s delay, while the bestower; donator is tested for hepatitis and other infections, distinctly if at a community hospital that relies forward sending out specimens for lab testing. Other than the heavy testing, I haven’t entirely understood for what cause FMT has not been more widely recommended being of the cl~s who first-line treatment.