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Forum Name: Gastroenterology Topics

Question: Prescription probiotics to treat C. diff?


 ahughes06 - Wed Jun 23, 2010 12:33 am

Female, 21 years old, I have a healthy diet with plenty of fruits and veggies, 5 meals a day and regular aerobic activity and strength training. I'm asthmatic, and during childhood I had chronic sinus infections. I was on harsh, broad-spectrum antibiotics for weeks at a time, at least one treatment every three months from the time I was six until I was about 11.

Needless to say, lots of gastrointestinal problems have ensued. Cramping, bloating, and diarrhea on a daily to ever-other-daily basis. I had a nissin fundoplication to treat a hiatus hernia three years ago, which some of the bloating can probably be attributed to. However....

I'm premed, and during microbiology class I had the opportunity to culture my own sample of clostridium difficile, and found that where other students had no colonies or very few (one or two), I had over 50. My professor agreed that they were all C. diff (cultured in strictly anaerobic environment on highly specific media) and that the numbers were reason for concern. Now to the question...

Should I ask my doctor for a prescription probiotic? I've heard bad things about over-the-counter products (most of the bacteria are dead, they're expensive and low quality, etc) and eating yogurt daily has had little influence on my symptoms. I realize this is a bit of self-diagnosis, but I think the link between my symptoms and test results are pretty stunning. Any other treatments besides probiotics? (I've heard vancomycin, but wouldn't that make it worse long-term?)

Thank you!!!
 Dr.M.Aroon kamath - Fri Jul 02, 2010 11:01 pm

User avatar Hi,
Indeed, it may be fair to say that your stool culture grew an "unknown" or "unidentified" strain of Clostridium difficile (C. difficile).

It occurs 'normally' in about 3-5% of healthy adults, and is common in babies and infants. Also, studies have shown that it is widely prevalent in the environment.

There are two types of clostridium difficile associated diarrhea (CDAD),
- hospital-aquired (nosocomial) &
- community-aquired.

An "Hypervirulant" strain has been found to be increasingly causing epidemics of CDAD worldwide.

Isolation of C. difficile from stool samples is important from the point of view of the epidemiological typing of strains.

In a given population, among the "carriers" of C. difficile there may be very few "carriers" of the "toxic" strains (relatively larger number of people are carriers for the "non-toxic" strains).

In cases of suspected CDAD, a "toxigenic" culture is a faecal culture should follow, in the case of positivity, by a direct immunoassay on colonies to detect toxin A production.

There are a number of tests for confirmation of the toxic strains.The most common confirmatory study is an enzyme linked immunoassay for C. difficile toxins A and B. This test is fairly cheap and easy, with results available in two to four hours. Specificity of the assay is about 90-100 %, & sensitivity ranges from 80-90 %.

Here is one study (the conclusions disputed by some), which may be of particular interest to you.

"Primary symptomless C difficile colonisation is associated with a decreased risk of CDAD. Although the mechanism is unknown, risk reduction is found in colonisation with non-toxigenic and toxigenic strains".
(http://www.ncbi.nlm.nih.gov/pubmed/9500319).

C. difficile grown from cell culture is perhaps, the most sensitive test, but this takes 48-72 hours; culture may be useful when enzyme assays fail to provide a clear diagnosis and direct visualization of the colon cannot be performed.

Role of probiotics in prevention of CDAD is beginning to be addressed. Probiotics initiated concurrently with antimicrobials for other infections,specifically, various lactobacilli & Saccharomyces boulardii have been studied.

A meta-analysis has been published in American Journal of Gastroenterology in 2006, which looked at prophylactic probiotic use for C. difficile-associated diarrhea. It evaluated six studies, each utilizing different probiotic strains, and found that overall there was a statistically significant protective effect with the use of these agents. However, within these studies, only S. boulardii was shown to reduce C. difficile recurrence rates. Given the outcomes of this and other studies, there might be potential for disease prevention with the concomitant initiation of antimicrobials and probiotics.(Community-Acquired Clostridium difficile Colitis, Emerg Med 39(7):37, 2007: By Sarah Perloff, DO, and David Horn, MD, FACP).

I hope this information may be of use to you.But i must warn you that the usage of probiotics in CDAD is still at best, investigational. You should only follow your doctor's advice.
Best wishes!

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