recurring Clostridium difficile

[lag_lorraine]

My father-in-law had his gall bladder taken out in November 2003, one week later had 20% of his colon taken out due to inflamation (inflammation) (he ate pizza 2 days after his gall bladder surgery). He had a leak that they couldn't pinpoint due to a duo dium(?) surger in 1927. After putting in a drain and taking him off all foods for 3 weeks, it healed and the drain was taken out. He contracted Clostridium difficile sometime between December 2002 and January 2003. He has had it again for a total of 9 times to date (from January 2003 to September 2003). We have treated him with the following in order:

1 Flagyl
2 Flagyl
3 vancomycin
4 Flagyl/vancyomycin extended treatment
5 vancomycin/Saccharomyces boulardii treatment
6 vancomycin/Saccharomyces boulardii treatment
7 vancomycin/rimfampin/Saccharomyces boulardii treatment
8 vancomycin/rimfampin/Saccharomyces boulardii treatment

Each of the above treatments left him C Diff free for about 1 - 2 weeks and then he would have a relapse.

9 (currently) flagyl/VSL#3/Saccharomyces boulardii treatment

We might have it licked this time (that's what we think every time). Has anyone heard of any other treatments? We've been to 3 different medical centers and everyone seems to be at a loss as to what else could be done.

[Kevin Pho, MD]

There has already been a comprehensive treatment for the C Diff.  Relapse occurs in 10 to 25 percent of cases of C Diff.  It typically occurs 1 to 2 weeks after completing therapy.  

One option would be pulsed antibiotic therapy in the following regimen using vancomycin:
Week 1 — 125 mg 4x/day
Week 2 — 125 mg 2x/day
Week 3 — 125 mg once daily
Week 4 — 125 mg every other day
Weeks 5 and 6 — 125 mg every three days

This has been shown in studies to help eliminate the C Diff for 6 months.

Still in the investigational stage, you may want to try intravenous administration of gamma globulin containing high titer IgG anti-toxin A antibodies.  In preliminary studies, this approach has shown some benefit in adults with recurring infection.  

Followup with your personal physician is essential.

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.

Thanks,
Kevin, M.D.

[yoshi]

how do you know it is c diff??

[yoshi]

just wonder??
did anyone mention that he could have a yeast/fungal infection from taking all these antibiotics??

[tia218]

I had a clostridium difficle infection back in July 1995.
I have some mild inflammatory bowel disease and then took a course of antibiotics for a sinus infection.

By day 3 the symtpoms began.

Initally i was treated with metronidizole and after 2 weeks wasa kind of okay.
The symtoms returned within 5 days of stopping the meds.

Again they used the same treatment, and the same thing happened.

eventually they gave my a 10 day vancomycin.. it resolved for slightly longer, but came back again within 2 weeks.
I then had a second higher dose 10 day course, but still it returned.

More appointments, more pain and finally a 30 days course of high dose vancomycin.

that finally did the trick, but obviously took a lot out of me.

When i was first ill i lost 25% of my bodyweight in 4 days, it took many months before i began to regain weight. I was down to 85lb at one point.

My pain and diarrhea symptoms persisted until the end of the year. Fortunatly i was clear of the infection, but the residual damage to my bowel was a problem.
In the January of 96 i began an 8 week course of steroids, prednislone, and eventually my symptoms resolved.

I would suggest asking for a longer course of vancomycin, and perhaps a higher dose too.

This is one hell of an infection to clear up, adn the consequences can be a nightmare. i avoid all antibiotics now unless i am very ill, and even then i worry so much, watching for any sign of problems.
The bug remains intyour system, only to be activated under certain circumstances, wehn the bodies protective bacteria are unable to work to protect against actual colonisation of this bacteria.

I wish your father all the luck in the world. I hope this maybe helps. Unfortunatly his experience is not that unusual with this difficult to treat bacteria.

[lag_lorraine]

We have had a positive test result for the C Diff prior to administering the medication. In fact, we had a bout of diarrahea and it took about 5 days before the test came back positive. I believe that was in June.

His weight has contined to come back, he lost about 30 lbs thru the beginnings of this infection, of which he's gained about 15 back. We watch him like a hawk.

Thank you all for your comments.

[PAJ]

This is an interesting article ,adapted by Russian cosmonauts apparently ,well they cultured healthy cosmonauts gut flora & used it to treat others ,did the trick , Take a look at my post on the 9/16/03 for more on gut flora

"Flora Power"—Fecal Bacteria Cure Chronic C. difficile Diarrhea
http://www-east.elsevier.com/ajg/issues/9511/ajg3277edi.htm

[Silver100]

im sorry to hear about your father in law.  this is a tough bacteria to treat, i should know.  i have taken flagyl 2 times, once for 10 days and then for 14.  i have just completed 2 weeks of vancomycin and unfortunately i can still feel the symptoms.  
i was reading in the c diff support site and someone has posted a natural remedy that you might want to try, here is the excerpt:

"I am free of clostridium and I did it by taking natural supplements instead of antibiotics. I got clostridium from a salad bar in Feb. One month later it was picked up in a test my nutrionist did. (I thought it was the flu or just my intestines acting up) He put me on 500 mg grapefruit seed oil(50 drops liquid or 500 mg tablets), 5 drops Betain HCL, 5 drops oregano oil, all taken 3 times per day. A month later I was 95% free, now I'm completely free of clostridium. My flora was poor before I got clostridium and it is still poor, now taking a flora supplement called Friends for Life, it's supposed to be very powerful"

maybe this might be worth looking into----good luck

[JamesRay]

A related discussion, C. difficile,  natural remedies was started.