A case of recurrent Clostridium difficile diarrhea.
Clostridium difficile is an important and increasingly common cause of nosocomial diarrhea. Recent epidemics of C. difficile-associated disease (CDAD) reveal a pathogen that is becoming more virulent, leading to an increase in disease severity, treatment failures, and relapses. Those of advanced age are at a particular risk of acquiring this debilitating and costly disease. This case describes CDAD recurring in an 87-year-old resident of a long-term care facility, which caused hospitalization. After five days of therapy on oral metronidazole with minimal improvement in diarrheal symptoms, the patient was switched to oral vancomycin. The patient subsequently improved and completed a 14-day course of metronidazole/vancomycin. The patient's stool was recultured shortly before finishing therapy and revealed C. difficile antigen; the patient was asymptomatic at that time, and it was therefore recommended to stop therapy after the 14-day treatment course. The patient was concurrently prescribed lactobacillus, a probiotic, for treatment of CDAD. The use of probiotics in the treatment of CDAD needs further study.
Virginia Commonwealth University/Medical College of Virginia, School of Pharmacy, Richmond, Virginia 23298-0533, USA. apakyz@vcu.edu
Amy
A
Pakyz
D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile; D003428:Cross Infection / Q000382:microbiology*; D003967:Diarrhea / Q000188:drug therapy / Q000382:microbiology*; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D007778:Lactobacillus / Q000187:drug effects; D008795:Metronidazole / Q000627:therapeutic use; D019936:Probiotics / Q000627:therapeutic use; D012008:Recurrence; D017211:Treatment Failure; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin