title: The potential use of cholestyramine to reduce the risk of developing Clostridium difficile-associated diarrhoea in patients receiving long-term intravenous ceftriaxone.
abstract: Intravenous pharmacotherapy with the third-generation cephalosporin ceftriaxone is unfortunately associated with a relatively high incidence of Clostridium difficile-associated diarrhoea. Cholestyramine (colestyramine) is an anion-binding resin which can bind luminal C.difficile toxin A (TcdA) and toxin B (TcdB) and which may be beneficial in the treatment of recurrent antibiotic-associated pseudomembranous colitis. We therefore hypothesised that concomitant oral cholestyramine might reduce the risk of C.difficile-associated diarrhoea in patients receiving long-term intravenous ceftriaxone. A pilot study was carried out in which it was found that only three out of 46 (6.5%) such patients being treated with 2 g ceftriaxone daily for Lyme borreliosis, who also received 4 g cholestyramine daily, developed C.difficile-associated diarrhoea. This is smaller than a published report of the incidence of this complication in six out of 26 (23.1%) patients following 1-3 days' treatment with 1 g intravenous ceftriaxone, but without oral cholestyramine (p=0.06). We therefore recommend that a larger, double-blind placebo-controlled trial be carried out to test this hypothesis.
authors.affiliation: Department of Medicine, Hammersmith Hospital, Imperial College London, UK. Electronic address: basant.puri@imperial.ac.uk.
authors.forename: B K
authors.initials: BK
authors.lastname: Puri
authors.affiliation: Breakspear Medical Group, Hemel Hempstead, Hertfordshire, UK.
authors.forename: J S
authors.initials: JS
authors.lastname: Hakkarainen-Smith
authors.affiliation: Breakspear Medical Group, Hemel Hempstead, Hertfordshire, UK.
authors.forename: Jean A
authors.initials: JA
authors.lastname: Monro
mesh_terms: D001426:Bacterial Proteins / Q000378:metabolism*; D001427:Bacterial Toxins / Q000378:metabolism*; D002443:Ceftriaxone / Q000009:adverse effects* / Q000627:therapeutic use; D002792:Cholestyramine Resin / Q000378:metabolism / Q000494:pharmacology*; D015331:Cohort Studies; D003967:Diarrhea / Q000209:etiology / Q000382:microbiology* / Q000517:prevention & control*; D004768:Enterotoxins / Q000378:metabolism*; D006801:Humans; D008193:Lyme Disease / Q000188:drug therapy*; D008954:Models, Biological; D010865:Pilot Projects
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile; D002792:Cholestyramine Resin; D002443:Ceftriaxone