Clostridium Difficile Colitis (cont.)
Dennis Lee, MD
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Jay W. Marks, MD
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
In this Article
- What is Clostridium difficile (C. difficile?)
- What Clostridium difficile colitis?
- How does Clostridium difficile cause colitis?
- What are the symptoms of Clostridium difficile colitis?
- Which antibiotics cause Clostridium difficile colitis?
- How is Clostridium difficile colitis diagnosed?
- How is Clostridium difficile colitis treated?
- Why are there relapses of Clostridium difficile colitis?
- How are relapses of Clostridium difficile colitis treated?
- What is new in Clostridium difficile?
- Find a local Gastroenterologist in your town
How are relapses of C. difficile colitis treated?
Treatment options for relapses of C. difficile colitis include:
- A second course of the same or a different antibiotic
- Six weeks of treatment with decreasing doses of
antibiotics
- An oral resin by mouth such as cholestyramine (Questran) that
binds toxins and inactivates them
- Non-pathogen (harmless) yeast by mouth such as Saccharomyces boulardii, for example, Florastor
Doctors usually treat patients who relapse with another 10 or 14 day course of metronidazole or vancomycin, and a majority of the patients so treated will recover. Nevertheless, some patients will have another relapse. Treatment options for multiple relapses include:
- Treatment with one of the options listed above that
has not already been tried.
- Vancomycin for six weeks in decreasing doses (125 mg
four times a day for one week, three times a day for another week, twice a day
for another week and so on), followed by four weeks of
cholestyramine
(Questran).
- Two weeks of vancomycin or metronidazole along with four
weeks of S. boulardii (Florastor).
- Fecal enemas from healthy relatives and family
members. Feces from non-infected donors are made into a suspension and
administered as enemas to the patient with multiple relapses. The normal
bacteria from the donor's stool displaces the C. difficile bacteria.
- Passive immunizations with human gammaglobulin.
Patients with multiple relapses typically have low levels of antibodies to C.
difficile toxins. By giving patients who relapse gammaglobulin containing
large amounts of antibodies to C. difficile toxins, the patients' levels of
antibody to C. difficile toxins are increased. Pooled human gammaglobulin can
be administered intravenously.
- Active vaccination for C. difficile toxins. Vaccination can increase a patient's levels of antibodies to C. difficile toxins. This is a new treatment that has not become widely available.
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