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Depending on a person’s medical history and severity of his or her clostridium difficile (C. diff) infection, a variety of treatment options exist. In order to determine the appropriate course of treatment, your doctor will evaluate your age, white blood cell count (WBC) – higher WBC counts usually indicate severe or complicated disease – and peak serum creatnine level. Complications are more common in patients with a WBC count higher than 15,000; a WBC count higher than 50,000 is indicative of a “truly catastrophic” disease course.
It is important to understand the results of your or a loved one’s blood tests, so you can make informed decisions about care.
The first step in treating C. diff is to stop taking the antibiotic (or other agent) that triggered the infection. For mild illness, this may be enough to relieve symptoms. But many people require further treatment.
Antibiotics
In an ironic twist, the standard treatment for C. diff is another antibiotic. These antibiotics keep C. diff from growing, which allows normal bacteria to flourish again in the intestine.
Side effects of metronidazole and vancomycin include nausea and a bitter taste in your mouth. It's important not to drink alcohol when taking metronidazole. For fidaxomicin, the most common side effects are nausea, vomiting, abdominal pain, gastrointestinal hemorrhage, anemia, and neutropenia.
For severe, complicated C. difficile disease, vancomycin administered orally (and by rectum, if obstructions are present) with or without intravenously administrated metronidazole is the regimen of choice.
Probiotics
Probiotics are organisms, such as bacteria and yeast, which help restore a healthy balance to the intestinal tract. A natural yeast called Saccharomyces boulardii, in conjunction with antibiotics, has proved effective in helping prevent recurrent C. diff infections.
Surgical Intervention
If you or your loved one is severely ill, your physician may recommend a subtotal colectomy (removal of the infected portions of the colon while preserving the rectum). Surgery is indicated by a white blood cell count rising to 50,000 and increased serum lactate levels, which are associated with greater perioperative mortality.
Recurrent disease
About one-fourth of people with C. diff get sick again, either because the initial infection never went away or because they're reinfected with a different strain of the bacteria. Treatment for recurrent disease may include:
- Antibiotics, which may involve one or more courses of a medication, a longer course of treatment or an antibiotic given once every two days,
- Probiotics, such as S. boulardii, given along with the antibiotic medication,
- Stool transplant (fecal bacteriotherapy), to restore healthy intestinal bacteria by placing donor stool in your colon. Although this is rarely done in practice, research has shown stool transplant to be helpful in selected cases.
Sources: Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and Infectious Diseases Society of America (IDSA); The Mayo Clinic.
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