Bisacodyl and C-Diff??

[annie.rn]

Question for the GI nurses out there. I've researched this and can't find an answer. I took care of a pt. recently w/ recurrent c-diff (3 hospitalizations and 3 fecal transplants plus rectal tube w/ a Vancomycin enemas). The GI doc prescribed Bisacodyl 10 mg po TID. Of course, he is pooping like crazy from the C-Diff. Can't think of why this would be prescribed. The pt. had refused it but I hope we are not botching something up by allowing him to refuse it. I work nights and never see the GI doc to ask him.

Do you know why? Just an over site? Only thing I could come up w/ was maybe to draw water into the bowel for some purpose...flush out the C-Diff?

Thanks for any ideas.

[NurseBeata]

I've recently had a similar situation occur. Had a patient with C. diff who was being given lactulose titrated to 3-4 BMs per day. There were several factors that required lactulose treatment: pt had liver damage (hepatic encephalopathy) with high ammonia levels. Where there other pre-existing conditions that might require laxative treatment?

There was an issue I didn't quite understand from an interventional standpoint, and if anyone out there could answer this, it would be super helpful. After the patient had ammonia levels checked and they were well within normal limits and they were cleared of C. diff, the doctors continued lactulose treatment. When asked whether the treatment should be discontinued, the resident stated that once patients with hepatic encephalopathy begin lactulose treatment, they do not stop regardless of ammonia levels. They simply follow the patient "clinically." Can anyone explain this rationale?

[I<3Endo]

Hi Annie,

I relayed your question to one of the gastroenterologists that I work with. He said there is absolutely no rationale for giving Bisocodyl for c-diff related diarrhea. He has heard of giving large amounts of Golytely in the hopes of flushing out the colon & resetting the bacteria balance but that is very ineffective as a rule.

He said the best bet in light of the failed fecal transplants (I'm assuming were given via colonoscopy) is to repeat the transplant from above (it is now available in a pill form w/good results to date).

Hope this helps!

Amy :)

[annie.rn]

Sorry for the delayed reply. My phone broke so I haven't been on here in a while. I am just today seeing this. I really appreciate you asking the GI doc you work with. I couldn't figure it out either. Glad to know I'm not the only one :-) Thanks so much!