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Clostridium difficile infection
Clostridium difficile is a spore-forming bacterium which
is probably most commonly 'caught' through the mouth often
in hospitals, especially after the use of antibiotics.
It can result in syndromes of varying severity including
transient diarrhoea, a carrier status, a mild colitis-like
illness, pseudomembranous colitis, and even toxic megacolon
with possible mortality.
Most affected patients can respond to medical therapy
including discontinuation of the responsible antibiotic.4
It is not the antibiotic that causes the infection but
rather the antibiotic use weakens the defence of the bowel
bacteria so permitting C. difficile to implant in the
bowel. Treatment with metronidazole (Flagyl), vancomycin,
rifampicin, teicoplanin or bacitracin can be successful
in clearing up the symptoms. However, despite a seemingly
successful initial treatment around 25% or more patients
may have a recurrence of diarrhoea following withdrawal
of these specific antibiotics. This is thought to occur
because the normal flora may not at this time, possess
the power to eradicate the persisting Clostridial spores.
In many patients the C. difficile spores remain and a
chronic, relapsing disease can continue. Treatment of
this recurrent C. difficile diarrhoea can be particularly
difficult, mainly because we do not have the tools to
kill spores. Various approaches to therapy have included
resins such as cholestyramine (Questran) and colestid
(Colestipol) granules, specific probiotics such as Lactobacillus
GG, Saccharomyces boulardii and intravenous immunoglobulin.5
Ultimately, if all medical therapies fail, re-colonisation
of the colon using human faecal origin probiotics has
been used and reported to be successful in eradicating
spores.6
The PTRC generally treats chronically ill patients who
have had recurrent C. difficile diarrhoea, colitis or
previous pseudomembranous colitis. We focus particularly
on those cases where other therapies have failed. In such
patients we may initially use a combination therapy with
vancomycin, rifampicin and metronidazole together combined
with Lactobacillus GG. If all pharmacological therapies
fail, human probiotic infusion (HPI) is used to terminate
the C. difficile infection since human faecal flora bacteria
appear to have the capability to permanently eradicate
C. difficile spores - a treatment not able to be matched
by any other currently known therapy. Using HPI, the cure
rate approaches 90-95%.7-13
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