jan,scott question on quantity of antibiotics and c-diff

As far as I know, C diff acts like an infection, but with a bacterium that produces very persistent spores that can stick around a long time. What I mean is that you have to be exposed to it to get it - Cipro alone cannot cause C diff. Nevertheless, the intestinal environment caused by some antibiotics, like Cipro, make us more susceptible to infection when exposed to C diff. I don't know of any evidence of a strict dose-dependency, though. It's hard to measure susceptibility accurately. Maybe Jan will turn up some mouse study that addresses this.

In any case, I think you should take the lowest dose of antibiotic that really accomplishes the purpose. This will reduce the likelihood of most of the side effects, even if it turns out not to change C diff susceptibility much. Avoiding proton pump inhibitors can help a bit, too.

The way Cipro and other antibiotics can cause a C. diff infection is by reducing or eliminating the normal flora that compete with C. diff and keep it controlled. You can't have a C. diff infection without exposure, but you also need to be susceptible. It is a common, widespread bacteria. They say that half the population is a carrier.

It would make sense that a lower dose of antibiotic should allow for more of your normal flora to persist and keep the C. diff suppressed. However, it would be dependent on the C. diff strain and how virulent it was. Still, cases of C. diff have been reported following a single dose.

That is a sort of complex way of giving you a wishy-washy answer of maybe-maybe not. Sorry. Best bet would be to pulse on and off, with the longest possible interval without the antibiotic.

Jan

Jan, do you have a source for that 50% estimate? The best sources I'm finding suggest that 10-20% of *hospitalized* patients carry C diff without symptoms. In any case, it doesn't change the advice. Taking antibiotics can have consequences, though I think antibiotics are a whole lot better than uncontrolled pouchitis.

Scott, I could not find my original source, which was probably a few years ago. Of course this was an estimate, based on how widespread this bacteria is in the environment. I think also, that article did not discern pathogenic C. diff (toxin forming) from non-pathogenic C. diff. Anyway, this Cleveland Clinic article states that colonization can be as high as 50% in hospitalized patients.

http://www.clevelandclinicmede...difficile-infection/

Jan

jan would love to pulse off..but right now it just does not work but will try again when i finish up my second week of levaquin..by the way since levaquin in same antibiotic class as cipro do you know if it is as detrimental as cipro in that cipro can cause various side effects?

As far as I know all fluoroquinolones have the same side effect profile. The main reason to choose one over the other is bacterial sensitivity. The more you use any particular antibiotic, the greater the risk of bacterial resistance.

http://www.merckmanuals.com/pr...luoroquinolones.html

Jan