March 27, 2012

The antibiotic clindamycin has long been strongly correlated with clostridium difficile infections. In fact, as far back as 1998, the Veterans Affairs Medical Center at Virginia Commonwealth University did a study proving that restricted use of clindamycin, not only reduced the incidence of C. diff among patients but also reduced the overall cost of treatment.

I have deep ambivalence about clindamycin use since my mother’s death from C. diff began with her being prescribed it for a dental procedure. Prior to my mother’s death, like most people, I didn’t question the necessity or efficacy of the prescriptions given to me by my doctors. Occasionally, I worried about possible side effects, but that was more a vague concern than a true fear. All of that changed in April 2010, with my mother’s death.

It’s no secret that antibiotics are widely overused. Studies show that American children will, on average, receive 20 doses of antibiotics before their 18th birthday. And, for upper respiratory infections in adults, which are largely caused by viruses, as many of 40 million unnecessary and ineffective antibiotic prescriptions are written every year. These unnecessary prescriptions can not only cause long term harm to our individual bodies by permanently damaging our intestinal flora, but our combined overuse is making infections like C. diff and MRSA stronger and more resistant to the treatments we have.

So what does all this have to do with the cute, little mouse over there?

A recent study by a research team at Memorial Sloan Kettering Cancer Center in New York City showed that a single dose of clindamycin wiped out 90% of bacteria types in mice intestines. While we mostly think of bacteria as something to be avoided, our gastrointestinal system relies on billions of good bacteria to digest food and protect us from harmful bacteria like C. diff. In fact, the bacteria in our guts is a huge part of our body’s overall immune system. By eliminating 90% of the bacteria in the study mice’s intestines, just one dose of clindamycin left them “unusually susceptible” to C. diff.  The infected mice “developed severe weight loss, and had a mortality rate of roughly 40 percent.”

Worst of all, the bacterial flora in the mice’s intestines did not regenerate. Martin Blaser, chair of the Department of Medicine at NYU Langone Medical Center, recently posited that the long term damage caused by antibiotic use may be fueling the epidemic of C. diff and MRSA transmission that costs tens of thousands of lives every year.

Does this mean we shouldn’t take antibiotics? No. Antibiotics are one of the greatest medical advancements in our history.  But it does mean that physicians should be upfront with those they’re treating with regard to the dangers inherent in taking these drugs. Every day hundreds of Americans die from C. diff infections and among those who survive many report not being told about the risk. Further research may indicate that treatment with clindamycin and other antibiotics require an aftercare plan to restore a patient’s bacterial flora.

At a minimum, physicians and patients should have an open and informed dialogue about the risks and benefits that come with using antibiotics. In some cases, antibiotics are clearly necessary. In others, it’s more of a judgment call. Patients should know that taking antibiotics for a minor bout of bronchitis is an option. But so is rest and fluids.

Americans should be engaged partners in their healthcare. But to do so we need to give up the myth that drugs like clindamycin are a panacea, confront the reality that all drugs carry some risk, and have physicians that are willing to engage in frank conversations about our treatment.

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  1. Rapid diagnostics can help with this problem. University of Maryland (JAC 2006 v.58 no.1 p.154-8) reported that when S. aureus was ruled out from an initial positive blood culture on inpatients, unneccessary vancomycin coverage could be discontinued on average two days sooner, and in some cases avoided entirely. Many hospitals use excessive vancomycin, but as diagnostics move from an average of 48 hours to only 20 minutes for such organism identification, progress on limiting unnecessary antibiotics in the hospital can be enabled.

    1. Christian says:

      Thanks so much for that interesting point, Philip. I’m going to check out that article you referenced.

  2. Kim Moody says:

    Good Afternoon. I hope you might be able to help Myself along with my Poor Daddy and Mama , Family!

    Does this inclued the following as well? I have been trying for some time now to find out how and who to report these diseases too. Acinetobacter, Providencia, VRE, E-Coli, Staph, Gram Positive, Gram Negative, Sepsis, Septic Shock! My Daddy is being eaten alive he has a gaping hole that measures 10″x6″ and the bone is exposed. My Poor Father has been in several Hospitals since September 25th 2011 and still is .It’s been over six months. This all started with a broken ankle and two days later he was put on Life Support and sent to a Acute Long Term Hospital for a Trach and to be weaned off life support and this is where it all started!! My Mother and the Family have been asked to have comfort care be involved and this is not a opption my Daddy has always asked for us too never give up on him no MATTER WHAT! So we have to continue with his Wishes!! I have so much that needs to be said however it would take me days if not longer too tell you what my POOR DADDY HAS AND IS GOING THROUGH!! I Thank you on Behalf off My Daddy Mama and Family… Kim Moody 🙂