C. difficile, a Cause of Serious Diarrhea
Dr. Robert Hardi is a gastroenterologist practicing in Chevy Chase and Rockville, MD. Dr. Hardi specializes in the digestive system and its diseases.nHe has special expertise in Inflammatory Bowel Diseases (Ulcerative Colitis and Crohn's Disease) as well as colon cancer screening, in which he has conducted numerous clinical... more
C. diff (as Clostridioides is commonly known) is a potentially life-threatening, serious bacterial infection of the gut, leading to a special type of colitis and severe diarrhea.
It has been recognized since the 1980s, as being due to certain antibiotics. By now it has been seen with practically all antibiotics, although not with equal frequency. The bacterium is everywhere but it forms spores, which are dormant. When the gut bacterial flora changes in certain ways, most commonly after antibiotic treatment, these spores turn into active, toxin-producing bacteria, causing illness. Once diarrhea occurs, people not treated with antibiotics can be infected, too. C. diff can be a serious problem in hospitals, nursing homes but even at home, too, when multiple members of a family use the same toilette seat. Using separate commodes, closing the lid before flushing, thorough handwashing with soap and water can substantially reduce infections.
The oldest treatment, Metronidazole, has become less effective due to bacterial resistance. Vancomycin, a non-absorbable antibiotic, is now widely available. Dificid, another antibiotic, has been gaining in popularity because it seems to reduce recurrence. Recurrence is a very serious problem. Retreatment, usually with Dificid, works but not always. Dificid and Vancomycin may be prescribed for longer times in different schedules. They may be augmented with Zinplava, and intravenous monoclonal antibodies, which further reduces the recurrence rate. After several, appropriately treated recurrences, a stool transplant usually works. The search for better-defined reconstruction of the gut flora continues.
