Talk:Clostridium difficile
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[edit] Studying C. Difficile
As part of my study at University, I have to study this organism and many of the subject areas around it. I am actually suprised by the amount of research linked to this one bacteria. Much more interesting than I was first expecting!
solo card 23:35, 24 February 2006 (UTC)
[edit] Sufferer
I just found this site while looking for information on clostridium difficile. I have been suffering with recurrent c-diff since September 2003. I have had three relapses. I was first put on Flagyl for 10 days. The c-diff recurred after off Flagyl four days. Next put on Vancocin 250 mg/four a day for 14 days. Four days off the Vancocin it came back. Next tried a pulse-dosing of Vancocin. When I got down to one every four days it came back. I took full dosage again and have tapered down to one every three days. I am symptom free at that dose. I am afraid to go longer that one every three days. But will at some point...don't want to be on this medicine forever.... The way I came down with c-diff : I have a mitral valve prolapse so took 3000 mg/amoxicillin in one day for teeth cleaning. One week later took Cipro 500mg three times a day for 10 days for UTI. Five days later had worse form of c-diff colitis. Psuedomembraneous Colitis. I am hoping to rid myself of this horrible bacteria soon. I had never heard of this before I came down with it. I am now an advocate for no antibiotics. And the overuse and abuse of them by physicians. If this helps one person think twice before blindly taking an antibiotic it will have been worth my time...
- Overuse and abuse? I don't know about the UTI but the prospect of endocarditis is not exactly thrilling either. JFW | T@lk 17:32, 22 December 2005 (UTC)
I'm sorry to hear stories like this, but certain antibiotics are associated with C diff more than others. Amoxicillin is very likely not the cause of your C diff infection, but cipro or ciprofloxacin is a fluoroquinolone and these antibiotics are one of the more common causes of C diff colitis. The other class of antibiotics with which this is common is the cephalasporins. Cipro may have been used in place of a first line agent like bactrim, but I obviously don't know your full history. As a pharmacist, I'll agree that antibiotics are often overused.
[edit] C Dif is a nightmare!
My son is 2 1/2 years old and he has C Dif...he had an ear infection a few months back and was given antibiotics...then a second dose of a different antibiotic when the ear infection was still there. A side effect of the antibiotic was loose stool, but when it continued long after he finished the antibiotic, he had his stool tested and was positive for C Dif. He was put on the Flagyl as well, which hasn't done a thing. It was also the nastiest medicine to have to give a child. The pharmacist tried to flavor it, but it leaves the worst after taste. I made the mistake of giving it to him after a meal, which was promptly vomited up...I'm waiting for the results of his second stool sample, and I'm sure that he still has it. This is a very difficult thing to deal with when it's a child- I will most certainly be questioning the necessity of any antibiotics he may need in the future...
[edit] Metronidazole
Hi, I know pretty much nothing about this organism. :) So, I don't know if this sentence near the bottom of the article is correct, incorrect, or just poorly worded.
"Two antibiotics are effective against C. difficile. Metronidazole is first choice because of superior tolerability, lower price and comparable efficacy."
This sentence implies that Metronidazole has both a lower price and comparable efficiency, but this sounds odd as it's supposed to be the first choice when fighting this thing. If it does indeed have a lower efficiency, that's fine, but if it has a superior one, then I think the sentence should be rephrased as "...superior tolerability, comparable efficacy and lower price." If someone could clarify this, that would be great. --Sparky the Seventh Chaos 05:23, May 22, 2005 (UTC)
Fact is - Metronidazole is a failure in more than %90 of the time. Metronidazole may work in a chem lab dish but it does not effectively cure this disease. The point is Metronidazole just does not work effectively and causes a more prolonged and severe condition. Please help yourself and kill the disease correctly. Be very careful with milk. If you have any questions please post them, This paramedic is here for you, and I apologize for any delay in getting your questions resolved.
Larry Gray
- Larry, please back this up if you could. What's the source of your data? JFW | T@lk 07:30, 24 Jun 2005 (UTC)
I will back it up. I took flagyl and it did not work. I took flagyl again and it did not work again. I took flagyl again and it did not work again. Vancocin worked very slowly but did have a positive effect. Eventually the “Z” combo antibiotic IV worked most effectively and took about two weeks of administering to zap this bacterium. The ramifications of flagyl (Metronidazole) were that the micro-organism had a longer opportunity to cause damage. A key in the treatment of this disease is catching it as early as possible. I asked a couple of doctors about flagyl and they also stated that flagyl rarely has any effect on C-diff. This information is very important because when your turn with this disease rolls the dice on you, it is very important to get the correct treatment the first time. Flagyl is the incorrect treatment. Flagyl is a biological failure.
In my experience with this disease I was one out of five in this out break. This is a situation were an individual had gotten their hands on contaminated cephelexin and began intentionally distributing the cephelexin in various forms in Aurora Illinois USA. The attacker initially poisoned herself and then discovered the poison and retaliated. Her mental condition that resulted from the self inflicted consumption of the poison caused her to feed the poison to several children and several adults. The local authorities ignored the call for help and she continued to distribute the poison as far as she possibly could and is still distributing the poison and no one will ever stop her. I share this experience because I ask “Are most C-diff” related outbreaks a result of terrorism?
Another shark attack is when the doctors give the flagyl to pediatrics. the pediatrics can not communicate back and reveal that the flagyl is incompetent.
- OK Larry, can you tell me the following: (1) Can you back up this rather unconvincing story of cephalexin terrorism with any links/publications? (2) Can you tell us what the "combo Z antibiotic" is? Do you own the patent? Or is it Zyvox®? (3) How can you justify giving 160mg of potassium over 8 hours indiscriminately? Will you stand by to resuscitate the patients when they develop a fatal arrhythmia?
- I urge you to back up your claims with serious evidence, or to stop bombarding us with your theories. JFW | T@lk 29 June 2005 10:10 (UTC)
I speak the truth - Stop confusing all and realize the only significance of this thread is that Flagyl is failure. What is your experience with this Disease? Cephelexin is mode of catching C-diff disease. Cephelexin couses C-diff outbreaks. the "Z" antibioyic is a combination antibiotic given intravenously. I understand that potassium is administered for loss of blood - due to the c-diff cousing internal bleeding. I ask you where does the fatal arrhythmia come in or is this just a comment to frown upon the people who seek information about this disease. My question is also are c-diff outbreaks mostly a result on intention or accident. You J obviusly dont know, so give others chance to have a voice about the disease. Tell J what is your expereince with C-Diff disease ?
- Always distrust someone who claims to possess the absolute truth. As a hospital doctor I have dealt with many (mostly cephalosporin-induced) cases of C. diff, most of which responded well to oral or intravenous metronidazole. Only on one occasion have we had to resort to teicoplanin, and that was because we needed something that could be administered intramuscularly.
- Always? 69.140.157.138 09:00, 24 June 2006 (UTC)
- Most cases are not associated with internal haemorrhage at all, and even so potassium levels are never corrected blindly by just randomly blasting 160 mmol at a patient. In someone who is normokalaemic, this could lead to ventricular arrhythmias and cardiac arrest.
- I am far from denying you a voice about C. diff and its complications, but many of your statements are outrageous enough to warrant backing up. Using cefalexin as a terrorist agent is a poor choice - it would only affect a small proportion of people.
- If Z is a combination antibiotic, could you tell me its constituents, or its presumed mode of action? It is bacteriostatic or bacteriocidal? Does it have Gram-negative or Gram-positive cover? Is it active against anaerobes? Is it potentially carcinogenic? JFW | T@lk 1 July 2005 06:48 (UTC)
- PS Googling for cefalexin and Aurora gives no results. Wikipedia:Wikipedia is not a news outlet, so unless there are actual reports of this case we cannot take responsibility for publishing it.
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- From a Doctor = always distrust someone who claims to speak the truth indicates that you as a doctor dont beleive the signs and symptoms of your patients. bad doctor but some good information has been provided, thankyou.
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- I didnt intend it to be a news. Anyways flagy is a failure. J please add more to this talk so people looking for information have more than enough information. Here are some ideas Doctor; Diet, what to eat what not to eat. Complications of prednisone in combination with C-diff disease. Is there a better quality than prednisone or does everyone have to use that third world medicine also. Just thirty years ago I heard there was no cure at all for c-diff disease. Thus the disease was painfully fatal. Please add more information to this talk page. How did you detect the c-fiff in the patients that did not have any signs and symptoms ?
"indicates that you as a doctor dont beleive the signs and symptoms of your patients" - this is nonsense. I don't distrust my patients, I just distrust you. So far nothing you have said makes sense.
"How did you detect the c-fiff in the patients that did not have any signs and symptoms ?" - well, not all C. diff infections cause hemorrhage. Hospitals screen patients with diarrhoea for C. diff toxin.
This talk page is not for information, it is to discuss the content of the article. Please explain what your concern is with prednisolone. And what was that "combination antibiotic Z" you were talking about? JFW | T@lk 01:15, 7 August 2005 (UTC)
Cephalexin can cause a c diff infection, but it not due to any terrorist activity. Cephalexin is a commonly used, broad spectrum antibiotic that kills the natural gut flora. This flora naturally inhibits growth of C diff in people who happen to have a colonization of said bacteria in their gut. This allows the C diff to overgrow into a large infection causing a pseudomembranous colitis and, more commonly, a severe diarrhea. And by the way, an infection of C diff WILL cause signs and symptoms.
[edit] Surveillance
how do we chat? noticed you did not see the connection between clostridium difficile and clinical surveillance. Maybe its the clinical surveillance site that is not a good one yet. But the reality is, information systems are becomming the new microscope of this new century. How does one create a up to date link that touches upon the social and public outcome measurement of population data and apply it to ones very specific illness?
my name is stef, my wiki name is culturejam. thank you for the discussion.
should the notable outbreak section evolve into a more encyclopedic "Epidemiology" would do this myself...would try and be unbiased and just the facts kind of writing.--Culturejam 23:20, 21 August 2005 (UTC)
- I reverted you because most of what you wrote was very abstract. "We use computers to track C diff" is a rather blanket and noninformational statement.
- In your new additions it is unclear which information is referenced to Tadataka, and which is from the Markov lectures. Please also note that Markov is a disambiguation page, and it is unclear what exactly you mean.
- In other words, perhaps you ought to work on clarity a bit. JFW | T@lk 23:42, 21 August 2005 (UTC)
[edit] New strains
This has just appeared online on NEJM.ORG. Why, for heaven's sake, is the first author called "Loo" by her last name? JFW | T@lk 01:46, 2 December 2005 (UTC)
- Well, unfortunately, that's her last name. See her page. I think it's possibly a Chinese last name, say, "盧" (lú). Anyway, she's not a toilet. :) -- Toytoy 16:02, 2 December 2005 (UTC)
Of course, but I thought it was fairly ironic in the context. JFW | T@lk 20:01, 3 December 2005 (UTC)
saw the article: it decribes what many doctors suspected for some time: there was another article, and comments from Barlet about how certain medicines increase the rates of change. quinolones can create all sorts of resistance patterns. there is an mit lecture somewhere about how markov models being applied to resistant bugs, ect--Culturejam 13:23, 15 December 2005 (UTC)
[edit] Resistant strains no longer rare
http://www.cnn.com/2005/HEALTH/conditions/12/02/deadly.bacteria.ap/index.html
It seems to be becoming more resistant and more commonplace. The CDC is a bit befuddled.
[edit] Pharmacology
By the way, pharmacology means the effect of the antibiotic on the pathogen. What is important to know in an infection is not the pharmacology; it is which antibiotic will be efficient, the dosage, duration of treatment, contraindications, second and third-line therapies, treatment of relapses, and in the case of C.diff, prophylaxis with probiotics is being tried in almost every hospital in Quebec which had the resistant strain. All this info is called pharmacotherapy. I'm a student in third year in pharmacy, Montreal, Canada, and my reference is the 2005 edition of DiPiro's Pharmacotherapy, the pharmacists' bible.
[edit] Lactobacillus
I re-added the Lactinex reference. A family member has had a bad run (pun) of c dif for a year and has been told to suppliment treatment with Lactinex. Since people are often given this recommendation, it seems appropriate that it is mentioned in the article by name. Superclear 15:34, 21 December 2005 (UTC)
- Hey Jfdwolff. Your not even close here. Lactinex is the most common type of probiotic (its main ingredient being lactobacillus) suggested by GI specialists to almost all lactose tolerant people with recurring c dif problems (call one, seriously, they'll tell you ... every one of them). This is far from original research. I'm going to put the reference back up since it does belong here. By the way, if probiotic treatment is going to all be considered original research better remove the references to yogurt, etc. Of course, if you object on other grounds we can discuss since you might be right (that even though it is well known research and will educate people who are "prescribed" lactinex, it should not be on this page).Superclear 15:25, 22 December 2005 (UTC)
Ok, WP:CITE then. JFW | T@lk 16:13, 22 December 2005 (UTC)
- I can find many many more until you relent :-) If you are the cite police you have an infinitely difficult job, but good luck. Almost nothing has citations on wikipedia. However, a google, medical, or other search engine might be a way to go about this sort of thing instead of assuming everyone is out to make things up (keeps people from getting unnecessarily defensive). Superclear 16:58, 22 December 2005 (UTC)
The first article cites Gorbach SL, Chang TW, Goldin B. Successful treatment of relapsing Clostridium difficile colitis with lactobacillus GG. (Letter) Lancet 1987;2(8574):1519. This is fine as a reference. JFW | T@lk 17:29, 22 December 2005 (UTC)
[edit] flagyl now vancomycin
was diagnosed with c-diff and took flagyl for 10 days. Went away about 5 days of taking it . Relief lasted for 10 days. Got a relapse. Did not get tested again but am now on vancomycin for 2 days. Let's see how this works out
[edit] C diff and Weight Loss Surgery
Another susceptible population for C. diff. is weight loss surgery patients, specifically those who have had intestinal reconstruction that includes a non-alimentary limb. These include patients who have had a Roux-en-Y gastric bypass and duodenal switch. These surgeries create a Y shaped intestinal tract, usually for the purpose of separating the biliopancreatic secretions from the food for a certain portion of the passage of food down the alimentary limb. This introduces an element of deliberate malabsorption (the bile acids and pancreatic enzymes are needed to solublize and break down fats, complex carbohydrates and protein, in order of decreasing malabsorption) and is for the purpose of enabling and maintaining weight loss by creating malaborption of those calorie sources.
The source of the C. diff. problem seems to be the biliopancreatic tract, as this portion of the intestine has much less flow of fluids to keep things moving, and therefore a relatively static condition sets in that allows for a bacterial overgrowth. This seems to be a good environment for C. diff. to take hold. In addition, many weight loss surgery patients are on chronic acid-reducing medication, which has been shown to potentiate C. diff. infection. --DCox 05:10, 30 July 2006 (UTC), 3 years out from my duodenal switch and so far C. diff.-free
[edit] The Treatment section may require "Cleanup"?
This cannot be taken seriously.
