help

I had a total gastrectomy about 7 weeks ago due to a stomach cancer diagnosis. Subsequently I developed a C diff infection for which I took Metronidazole for 3 weeks. During the third week  the doctor took the test 3 times and they were all negative. My diarrhea symptoms subsided considerably after 2 weeks of medication but they seem to have returned today although not very severely. I am concerned that I may have a relapse. I have a relatively small window to get rid of this infection because i need to do my 2nd round of chemo in the next 2-3 weeks. Does the fact that the test was negative mean that infection is totally gone? if not, what is the best course of treatment over the next couple of weeks? I am also on TPN currently because I have lost a lot of weight from the chemo, the operation and the c diff.

[Kevin Pho, MD]

A negative test does not completely exclude CDiff.

That said, I agree with the metronidazole you had for antibiotic treatment.  There are some refractory cases which require alternative medications, like oral vancomycin, as well as the addition of probiotics as well as cholestyramine.

Other options for refractory cases include the antibiotic Rifaximin, as well as intracolonic vancomycin.  

Surgery is reserved for the most serious cases.

These options should be discussed with your GI specialist.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.

KevinMD.com
Twitter.com/kevinmd

[Matthew007]

i'm also suspecting c. diff with my problems..

copied from another site..

For most cases of more severe Clostridium difficile-induced colitis, the antibiotic metronidazole Some Trade Names
FLAGYL
is usually effective against Clostridium difficile. The antibiotic vancomycin Some Trade Names
VANCOCIN
is reserved for the most severe or resistant cases. Some people require bacitracin Some Trade Names
AK-TRACIN
or Saccharomyces boulardii, a yeast probiotic. Symptoms return in up to 20% of people with this disorder, and treatment with antibiotics is repeated. If diarrhea returns repeatedly, prolonged antibiotic therapy may be needed. In very rare instances, people are treated with preparations of lactobacillus given by mouth; an enema of fecal material, which recolonizes the intestine with normal bacteria; or intravenous gamma globulin. Doctors are studying whether the antibiotic rifaximin will prove effective in treating Clostridium difficile-induced colitis and whether vaccination against Clostridium difficile may help in the treatment of refractory (treatment-resistant) disease and even prevent the disease in people at risk.

I'd ask your doctor to put you on Vancocin (warning it's expensive from what I hear) and usually the longer the duration the better chance for success.  Also i've heard some doctors use a "pulse" antibiotic therapy trying to get rid of the c. diff.   I have WBC in my stool and i'm not sure what they're from.  My cultures are negative but so are all my tests (colonoscopy/endoscope biopsies ect) so good luck!

[Matthew007]

also a heads up..i'd buy some nice probiotics and go crazy on them during treatment (not taking them at the same time of course but hopefully the second you go off your antibiotic the good bacteria will move right in place of the c. difficile...)

[Matthew007]

oh duh sorry thought this was the general forum.  I'm sorry - hopefully the dr. expert will give you good answers.