September 18th, 2008

C. diff: The cure for antibiotic abuse

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.

2 Responses to “C. diff: The cure for antibiotic abuse”

  1. […] C. diff: The cure for antibiotic abuse Posted by Paul Sax on September 18th, 2008 […]

  2. Woofda9 says:

    A bad toothache and allergic reactions to Penn, PennVK and Amoxicillin and I got a script for clindimycin. Three days into it, C. diff. signs and I kept taking it “make sure you take ALL the doses as prescribed” so I did. Then the diarrhea and BAM! it had me. Trying to get more information, I found resources conflicting–take no loperidine or it is okay ; avoid dairy, yet eat yougurt, drink fluids, but not juices. Now, I am wondering how it will effect my immune system, my medications float in the toilet, so I know they aren’t doing what they are supposed to and aside from being dehydrated, I am depressed and feel like crap. My toothache came back and I still can’t get it pulled, and now I am freaking because I don’t want to give this bug to anyone else. So I did more research, but there really needs to be more information for us with HIV about, diet, treatment and oh yes, relapses….

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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