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was wondering does it make sense that if one reduces their antibiotic intake to say half a normal dosage that you reduce you risk for getting c-diff again by some degree....or is it immaterial an antibiotic is an antibiotic..

do not know if one can answer that but it would be nice to know with diet although not off antibiotics i might have reduced risk of reoccurring c-diff

anyone besides scott and jan i welcome your thoughts on this

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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.
Scott F
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 Smiler
Jan Dollar
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 F
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 Smiler
Jan Dollar

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