C. Difficile becoming more virulent

Tara Parker Pope's column in the New York Times this morning about C. Difficile illustrates the continuing issues we have with the overuse of antibiotics. Here are some excerpts from the piece.

Clostridium difficile is a contagious and potentially deadly bacterium. Although the illness is difficult to track, health officials estimate that in the United States the bacteria cause 350,000 infections each year in hospitals alone, with tens of thousands more occurring in nursing homes. While the majority of cases are found in health care settings, 20 percent or more may occur in the community. The illness kills an estimated 15,000 to 20,000 people annually.

What is so frightening about C. difficile is that it is often spurred by antibiotics. The drugs wipe out the targeted illness, like a urinary tract or upper respiratory infection, but they also kill off large portions of the healthy bacteria that normally live in the digestive tract. If a person comes into contact with C. difficile, or already has it, the disruption to the beneficial bacteria creates an opportunity for the harmful bacteria to flourish.

The public health community has been sounding the alarm for years about the overuse of antibiotics and the emergence of “superbugs” — bacteria that have developed immunity to a wide number of antibiotics. “One of the things that we counsel consumers about is to make sure that an antibiotic is really necessary,” said Dr. Dale N. Gerding, an infectious disease specialist at the Stritch School of Medicine at Loyola University in Chicago. “There are many good reasons for taking an antibiotic, but an illness like sinusitis or bronchitis winds up being treated with antibiotics even though it will go away by itself anyway.” Even appropriate use of antibiotics can put a person at risk. Dr. Gerding said his own adult son came down with a C. difficile infection after taking antibiotics for tonsillitis.

The typical treatment for C. difficile is another course of antibiotics, typically the drug vancomycin. But the situation can quickly turn tragic. The Centers for Disease Control and Prevention has reported on several cases of pregnant and postpartum women who developed life-threatening C. difficile infections after being treated for minor infections. In some instances, a C. difficile infection can be treated only by emergency surgery to remove the patient’s colon. Doctors say many patients report that they continue to suffer from regular bouts of diarrhea even after the infection is gone. About 20 percent of patients with the infection suffer a relapse, and C. difficile support groups have emerged on the Internet.

C. difficile is not a new illness, but it appears to be spreading at an alarming rate. The rate of C. difficile infection among hospital patients doubled from 2001 to 2005, according to an April 2008 report from the C.D.C. The rise in C. difficile cases around the world is linked with the growing use of all antibiotics, particularly a class of drugs called fluoroquinolones, which came into widespread use around 2001. The use of acid-suppressing drugs, including proton pump inhibitors like Prilosec, also may be a risk factor, although studies have been contradictory.

In addition to becoming more common, C. difficile is also becoming more deadly. Several years ago, the mortality rate from a C. difficile infection was around 1 to 2 percent. But today, various studies estimate that the death rate is 6 percent. The reason is that a hypervirulent strain has emerged that emits higher levels of toxins than earlier strains.

Bonnie - as is the case with the rise of a more well known superbug, methicillin-resistant Staphylococcus aureus (M.R.S.A), C. Difficile is directly related to the overuse of antibiotics. As I have said incessantly, antibiotics should be administered only if it is absolutely essential. I cringe when I read about drug stores and pharmacies giving out free antibiotics as a promotional tool.

The other crucial lesson taken away from this piece is that anyone who has to go on an antibiotic must supplement with high dose probiotics to lower the risk of losing their healthy gut flora. My clients who have adhered to this philosophy have seen vastly improved outcomes.

My general recommendation during antibiotic therapy is as follows:

• Take 250 mg. saccharomyces boulardii (with each antibiotic dose) to reduce antibiotic-induced damage to probiotic populations
• Take a nutraceutical-grade probiotic (lactobacillus acidophilus strain preferred) at least two hours away from antibiotic 2-4 times daily
• Continue with this regimen for at least 1-2 weeks after you finish antibiotic therapy

In conclusion, I am now recommending that most people supplement with a maintenance dose of probiotics (lactobacillus acidophilus and bifido bacterium minimum) on a daily basis. There are so many outside forces that pound away at our healthy gut flora. We need reinforcements!