HIV and ID Observations

Even with market doom-and-gloom dominating the news, there’s a good article in yesterday’s Wall Street Journal on Clostridium difficile (C. diff).  It gives an accurate summary (in lay language) of the problem, several pertinent clinical anecdotes, and quotations from national experts.

But this part in particular caught my eye:

She says that among other measures, the hospital has cut its post-operative antibiotic doses for all joint-replacement surgeries to two from three to avoid C. diff infections.

No offense intended, but anytime “routine” antibiotic use is reduced on surgical patients, it’s notable.  Practically reportable.  (One might question why any post-operative antibiotic doses are given at all — but we’ll take this small victory anyway.)

Human beings love antibiotics — all of us are guilty of this love affair, health care providers and patients alike.  (This is a great cartoon!)  My first introduction to this phenomenon was during a medicine rotation in medical school, when the esteemed senior physician on rounds obviously had a bad cold.  After a particularly noisy bout of sneezing (and what was he doing in the hospital, one might wonder), he confessed that the cold he could deal with — but the nausea from the erythromycin he’d prescribed for himself “just in case” was driving him crazy.

But this new “hypervirulent” C. diff has changed the equation, in a way that warnings about antibiotic side effects and risk of resistance never could.  One of my friends, a maxillofacial surgeon, thinks long and hard about every antibiotic prescription ever since one of his patients had severe C diff — requiring a colectomy and prolonged ICU stay — after a brief outpatient course of clindamycin.

And those unfortunate patients who have had C diff have been thoroughly cured of any “just in case” mentality towards antibiotics for sniffles, colds, sore throats, minor sinus issues, and coughs.  Alas, a case of C diff is more effective than “Your cold is caused by a virus; antibiotics don’t work for viruses,” which oddly has little traction at all.