Last semester I did a research paper on the use of probiotics and prebiotics in the treatment of C-diff infection and ulcerative colitis. Here is a section of that paper. Sentences are referenced, and if you want to know the sources that I referenced let me know and I will provide them.
Clostridium difficile infection, the most common nosocomial infection in the United States, usually occurs secondary to antibiotic therapy. Antibiotic therapy alters the colonic microecology leading to the loss of the protective microbial flora which are susceptible to the antibiotic, and enables pathogens to proliferate (8). Clostridium difficile is a gram-positive, sporulating anaerobic bacillus that typically does not colonize in the gut but does so only in approximately 5% of healthy adults (9), and it can colonize in the gut of hospitalized patients leading to the production of harmful toxins causing colitis and diarrhea. Approximately 21% of hospitalized patients will become colonized with Clostridium difficile and one third of them will become symptomatic (8).
Hospitalized patients are more susceptible to exposure to Clostridium difficile because the spores of this bacteria have been found on toilets, metal bedpans, and floors of hospitals, and these spores can exist on environmental surfaces for months (10). Patients can also become infected from the hands of healthcare workers, and poor handwashing technique can contribute to infection. Once a patient is infected, the bacteria do not invade the gut mucosa but produce harmful toxins which can lead to symptoms. The disease can progress to the formation of an overlying coating of fibrin, leukocytes, and necrotic colonic cells on the gut causing the formation of a pseudomembrane, hence the name pseudomembranous colitis (10). The development of pseudomembranous colitis can lead to hemorrhage, tonic megacolon, hypovolemia, bowel perforation, and death (10).
The patients most at risk include ones with severe underlying disease due to immune system compromise, ones encountering gastrointestinal procedures and manipulation that affect gut motility, ones receiving chemotherapy due to the agents causing microbial imbalance, and the use of enemas and gastrointestinal stimulants that alter gut chemistry (10).
Conventional treatment for Clostridium difficile pseudomembranous colitis
Supportive therapy consisting of discontinuation of antibiotics and use of fluid and electrolyte replacement should be first attempted, and antiperistalic drugs should be avoided to prevent the pooling of toxins in the colon (9). This may be enough to treat a mild case, but antimicrobial therapy may be needed in severe cases to treat the infection. Metronidazole and vancomycin are the most common medications used in the United States because they inhibit the growth and toxin production of Clostridium difficile. The patients are usually given a 7-10 day course orally (9). Metronidazole is the preferred first drug of choice because it reduces the risk of the spread of vancomycin-resistant enterococci (VRE), it is less expensive, and it is as effective as vancomycin (9). Vancomycin is given if the patient does not respond to metronidazole. The patient will be in a private room on isolation precautions to prevent the infection from spreading to other patients.
With the treatment of antimicrobials for this condition, the normal colonic flora can be further disrupted and spore formation can be promoted leading to a relapse of symptoms that can occur in approximately 20% of patients (8). The colonic flora may not return to normal for several months after antibiotic therapy, so the avoidance of antibiotics as much as possible will accelerate the return of the protective normal colonic flora (9). Relapses usually begin with diarrhea 2 weeks to 2 months after successful antimicrobial therapy, and relapses are less likely to occur if the patient was treated with supportive therapy (9).