Clostridium difficile is a strain of bacteria that can overgrow and cause a potentially severe infection in the large intestine. When antibiotics are used to fight infection elsewhere in the body, they sometimes have the side effect of killing off good bacteria residing in the colon that maintain a healthy environment. Then the Clostridium difficile can multiply rapidly, causing severe diarrhea and other symptoms, especially in people who are elderly or chronically ill.
Discontinuation of Antibiotics
Stool studies should be done to confirm the presence of C. difficile when symptoms of diarrhea, fever and abdominal pain are present after a recent course of antibiotics. Dr. Michael S. Schroeder, a physician with Kaiser Permanente in Fontana, California, advocates discontinuing antibiotics, when possible, that precipitated the condition. This measure resolves 15 to 23 percent of cases, according to a 2003 study published in "Connecticut Medicine."
Metronidazole
The standard initial treatment for C. difficile colitis, inflammation of the colon resulting from the bacterial overgrowth, is 500 mg metronidazole given orally or intravenously four times daily for 10 to 14 days.
Vancomycin
If symptoms persist on metronidazole and stool samples continue to show presence of the bacteria after 5 days, the next step is to treat with 500 mg vancomycin orally. Intravenous treatment with this medication is not effective because the drug does not reach the bowel unless routed through the gastrointestinal tract. According to data reviewed by Dr. Schroeder, the response rate to this treatment is better than 90 percent.
Antidiarrheal Agents
Using an agent, such as diphenoxylate, that reduces motility is contraindicated. Merck.com explains that using antidiarrheal medications can worsen a case of C. difficile, as reducing intestinal motility increases the time the intestine is exposed to the toxin produced by the bacteria.
Probiotics
Repopulating the colon with a healthy environment requires replacing some of the beneficial bacteria lost in the course of antibiotic treatment. In the January 2010 issue of "Today's Dietitian," Christen C. Cooper, M.S., R.D. describes the ways these healthy bacteria---also known as probiotics---can work to keep the gut healthy: they strengthen the quality of the lining inside the intestine; some of the beneficial organisms reduce the pH of the environment, deterring the growth of the harmful ones; and the Lactobacillus species produce compounds that retard the growth of harmful bacteria. The National Center for Complementary and Alternative Medicine notes that the use of probiotics may shorten the infection time of a C. difficile infection. Probiotics can be added to the diet in the form of a capsule, or they can be ingested from foods such as yogurt or fermented milk.
References
- "American Family Physician"; Clostridium difficile-Associated Diarrhea; Michael S. Schroeder, M.D.; March 2005
- "Connecticut Medicine"; Treatment of Clostridium difficile-Associated Disease; Florea NR, et al.; 2003
- Merck.com: Clostridum difficile-Induced Colitis
- "Today's Dietitian"; Probiotics in Pediatrics --- Using Friendly Bacteria to Treat Health Conditions; Christen C. Cooper, M.S., R.D.; January 2010
- National Center for Complementary and Alternative Medicine: An Introduction to Probiotics
