Clostridium difficile -Current Battlelines

The most recent how to treat Clostridium difficile with fecal microbiota transplantation is described in a review article, Clinical Gastroenterology & Hepatology; 2011: 9:1044-49.  This article details the rationale and effectiveness of this approach.  Indications include 2-3 recurrent episodes or moderate/severe episode not responding to conventional treatment. Workup for donors to minimize the risk of transmission is discussed.  The article points out that fecal transplantation can be accomplished by nasogastric or transpyloric tubes or can be delivered directly via colonoscope or via retention enema.

Additional information on this topic:

Am J Gastro 2000; 95: 3283-5.
Clin Inf Dis 2003; 36: 580-5.

More C difficile references:

  • NEJM 2010; 364: 422, 473. Fidaxomicin – a macrocytic abx –more effective than vancomycin (92% vs. 90%) and with lower recurrence (15% vs 25%). Dose 200mg BID. n=629.
  • NEJM 2010; 362: 197, 264 (editorial). 1st article: n=200. Rx with monoclonal antibodies (against toxins A & B) -single infusion (10mg/kg) –reduced recurrence rate from 25% vs 7% & among those with previous recurrence, the rate was reduced from 38% to 7%.
  • NEJM 2011; 365: 1693. Host/pathogen factors. n=4143.
  • Gastro 2009; 136: 1152, 1206. “reining in recurrent C. diff”
  • JPGN 2009; 48 suppl 2: S63-65. Cohen MB. ~35% of patients now w/o antibiotic exposure.
  • Curr Opin Gastro 2008; 25: 24-35. Use of sacchromyces boulardii(1gm/d)x 2 weeks w Vanco may reduce recurrence by >50&.
  • Journal of Pediatrics 2009; 154: 607. n=198.  Virulent NAP1 strain present in~19% from 2 children’s hospitals.
  • NEJM 2009; 360: 637. C diff (even toxigenic strains) present in ~50% of healthy newborns. Not convincingly associated with any illnesses in newborns –possibly due to lack of receptor in infants (J Clin Invest 1992; 90: 822-9).

 

8 thoughts on “Clostridium difficile -Current Battlelines

  1. Pingback: Fecal transplant -now mainstream | gutsandgrowth

  2. Pingback: Clostridium difficile in IBD | gutsandgrowth

  3. Pingback: FMT -not quite the new Laser | gutsandgrowth

  4. Pingback: Fecal Transplants -NY Times Opinion Piece | gutsandgrowth

  5. Pingback: Precise Identification of C difficile Transmission | gutsandgrowth

  6. Pingback: A C difficile two-fer | gutsandgrowth

  7. Pingback: Trends in Clostridium difficile Infection | gutsandgrowth

  8. Pingback: Something New with FMT | gutsandgrowth

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.