Management Recurrent C. Diff
C. diff infection not only is caused by antibiotic use; it is also treated with antibiotics. That pushes patients into a downward spiral in which the microbiome slides further out of balance, C. diff bacteria proliferate, more antibiotics are given, and so on all the way down. Fecal transplants stop that spiral cold - Maryn McKenna
HWN Suggests
The Latest Poop On Fecal Transplants Vs. Antibiotics For C. Difficile Diarrhea
How can more poop actually help with severe diarrhea? Isn't that like asking for buckets of water during a flood? Well, when the diarrhea is caused by the antibiotic-resistant bacteria Clostridium difficile, a poop (scientifically called fecal) transplant may help get to the bottom of the problem...
In a fecal transplant, you basically take poop from one person and insert it into another person. Before you say, "great, how do I sign up," keep in mind that there are medical reasons to do this. In this case, the purpose of having a C. difficile-infected patient deal with someone else's (insert word for poop) is to introduce "good" bacteria from the poop of someone who does not have…
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Updated Guidelines on Management of Clostridioides difficile Infection in Adults
What is the preferred therapy for recurrent CDI episodes? In 2021, the guidelines now suggest fidaxomicin rather than intracolonic vancomycin to improve sustained response after therapy. Are there any changes regarding the use of fecal microbiota transplantation? Essentially, no. However, it should be noted that since the 2017, three separate safety alerts have been published by the U.S. Food and Drug Administration. Two alerts pertain to Escherichia coli transmission from donor to transplant recipients, and the other documents concern for SARS-CoV-2.
Articles of Interest
Antibiotics Weren’t Used to Cure These Patients. Fecal Bacteria Were
In a small study, doctors used so-called fecal transplants to treat a serious gut infection in patients. The transplants, from healthy donors, were as effective as antibiotics.
Stool transplants are now standard of care for recurrent C. difficile infections
The main risk factor for CDI is taking antibiotics, which is why doctors discourage unnecessary antibiotic use. Ironically, first-line treatment for CDI is also antibiotics. About 20% of people treated with antibiotics will develop recurrent infections, and the best way of clearing recurrent CDI is with FMT. This is supported by several guidelines. The reason why FMT works so well is largely unknown, but generally speaking it restores important helpful bacteria that help protect against CDI. But while supported by guidelines, FMT is still considered investigational and is not currently FDA-approved.
When Feces Is the Best Medicine
Fecal transplants have been proven to successfully treat certain types of infection, but proponents of the treatment are still fighting what they say are unnecessarily strict regulations.
When Poop Becomes Medicine
But poop is no panacea either. Scientists have treating all kinds of disorders with fecal transplants with mixed results, while a burgeoning community of DIY enthusiasts have tried the treatment without due awareness of its many risks.
A novel ‘smart’ antibiotic may target most common bacterial infection contracted in US hospitals
The current antibiotics used in clinical practice kill many beneficial bacteria in the gut as well as the pathogenic target organism. This loss of good microbes causes an unhealthy shift in the bacterial population in the gut that is referred to as dysbiosis. After the beneficial bacteria are wiped out, C. difficile occupies the void left behind.
Promising New Treatment Emerges For Deadly C. difficile Colitis
One important difference is that hands must be washed with soap and water—not an alcohol hand sanitizer—as alcohol is ineffective in killing the spores. So for Hand Hygiene Day, remember to wash your hands.
Why Would Anyone Get a Fecal Transplant?
It isn’t very often that a medical procedure inspires a patient-advocacy movement, let alone an Internet fan club. Especially not a procedure that is, well, icky. But that’s undeniably what has happened with fecal transplants, a low-tech practice from back in medical history that has worked its way from outlaw home procedure to papers in major medical journals and a Food and Drug Administration clinical trial.
Resources
Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection
In summary, a single intravenous dose of bezlotoxumab against C. difficile toxin B, when given with standard-of-care antibiotics, provided protection against recurrent C. difficile infection for up to 12 weeks that was superior to that provided by treatment with standard-of-care antibiotics alone. Bezlotoxumab has a novel mechanism of action that reduces the likelihood of recurrent C. difficile infection, most notably among patients who have an increased risk of this unfavorable outcome.
Rebyota
REBYOTA (fecal microbiota, live – jslm) is indicated for the prevention of recurrence of Clostridioides difficile (C. diff) infection in individuals 18 years of age and older, following antibiotic treatment for recurrent C. diff infection. REBYOTA is delivered rectally to your gut microbiome, where it’s needed.
Vowst
The first and only FDA-approved microbiota-based therapeutic in oral capsules to prevent C. diff recurrence following antibacterial treatment. A clinical study showed that 2 months after taking VOWST, most people were recurrence free and continued to be even 6 months later.
Peggy Lillis Foundation
Peggy Lillis Foundation is building a nationwide C. diff (Clostridioides difficile) awareness movement by educating the public, empowering advocates, and shaping policy.
