January 22, 2010 | 6:12 pm
Posted by Albert Fuchs, M.D.
You may not yet have heard of the bacterium Clostridium difficile (C. dif.), but in the next few years it will likely become a household name, as well known as Staph and Strep. C. dif. causes a severe infection of the colon leading to severe diarrhea. It frequently results as a consequence of antibiotic use. Antibiotics can kill the normal intestinal bacteria and allow harmful bacteria like C. dif. to proliferate.
Decades ago, C. dif. infection was a minor nuisance, but in the last decade, due perhaps to increasing use of broad-spectrum antibiotics, C. dif. has become more common and more severe. Many patients, especially older patients, require hospitalization for C. dif. diarrhea. Besides causing severe dehydration, C. dif. can cause systemic infection and sometimes death.
Ironically, the typical treatment for C. dif. colitis is antibiotics. But since antibiotics don’t allow the normal gut bacteria to return, recurrence of C. dif. diarrhea after treatment is completed is a frequent problem. In hospitals and nursing homes spread of C. dif. has become a menace.
A study published in this issue of the New England Journal of Medicine offers hope against this worsening problem. The study randomized 200 patients with C. dif. diarrhea. All patients received conventional antibiotic treatment. Half the patients also received a new intravenous antibody directed at C. dif. toxin; the other half received intravenous placebo. The results were encouraging. Only 7% of the patients that received the intravenous antibody developed another episode of C. dif. infection, compared to 25% receiving placebo. That means that for every about six patients that receive the antibody, one recurrent infection is prevented.
This new treatment will have to undergo larger trials before it is approved. In the meantime the cornerstones of C. dif. prevention remain judicious antibiotic use and preventing spread between patients in hospitals and nursing homes.
New England Journal of Medicine article: Treatment with Monoclonal Antibodies against Clostridium difficile Toxins
New England Journal of Medicine editorial: Clostridium difficile — Beyond Antibiotics
Forbes post on The Science Business: Why You Should Care About Treatment with Monoclonal Antibodies against Clostridium difficile Toxins
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