Clostridium Difficile: Treatment, Procedure, Cost and Side Effects

Clostridium difficile is referred to as clostridia.It is spindle-shaped bacterial cell especially one swollen at the center by an endospore .

Clostridium difficile is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon.Illness from C. difficile most commonly affects older adults in hospitals or in long-term care facilities and typically occurs after use of antibiotic medications. How-ever, studies show increasing rates of C. difficile infection among people traditionally not considered high risk, such as younger and healthy individuals without a history of antibiotic use or exposure to health care facilities.

The decision to treat C difficile infection (CDI) and the type of therapy administered depend on the severity of infection, as well as the local epidemiology and type of C dif-ficile strains present. Except for preoperative prophylaxis, it is recommended that the use of cephalo-sporin and clindamycin be restricted for infection prevention. No treatment is necessary for asympto-matic carriers.

For patients with non epidemic, non severe CDI clearly induced by antibiotic use, with no signs of severe colitis, it may be acceptable to stop antibiotic treatment and observe the clinical response for 48 hours.Antibiotic treatment is recommended for all except very mild cases ac-tually triggered by antibiotic use; suitable treatments include metronidazole, vancomycin, and fidax-omicin.For mild/moderate disease, oral metronidazole (500 mg 3 times daily for 10 days) is recom-mended as initial treatmentIn patients for whom oral treatment is inappropriate, fidaxomicin may be used specific indications include first-line treatment in patients with recurrence or at risk for recur-rence.

Pharmacologic therapy should be tailored according to the severity of C difficile infection (CDI). Treatment is not indicated for asymptomatic carriers. In very mild cases (ie, patients without fever, abdominal pain, or leukocytosis), in patients who do not have other comorbidities, cessation of causa-tive antibiotics may be the only treatment necessary.Approximately 15-25% of patients respond to conservative therapy, which allows for reconstitution of normal colonic flora and reduces the risk of relapse.

Specific therapy aimed at eradicating C difficile is indicated if symptoms are persis-tent or if antibiotics cannot be discontinued safely.Oral metronidazole and oral vancomycin have simi-lar efficacy rates in treating diarrhea caused by C difficile in mild to moderate infection but not in se-vere disease. Whereas metronidazole is the recommended first-line treatment for mild to moderate dis-ease without complications, vancomycin is recommended first-line therapy for severe infection or for patients with risk factors for adverse outcomes, such as advanced age, critical illness, overall debility, or inflammatory bowel disease (IBD). Vancomycin, rifaximin, and fidaxomicin are useful in recurrent or persistent cases.

The oral administration of these medications is the preferred route, be-cause C difficile remains within the colonic lumen without invading the colonic mucosa. Vancomycin is poorly absorbed in the intestinal tract, thereby promoting high concentrations within the intestines while significantly reducing the prevalence of adverse systemic effects.

The most common symptoms of mild to moderate C. difficile infection are:Watery diarrhea three or more times a day for two or more days,Mild abdominal cramping and tenderness.In severe cases, people tend to become dehydrated and may need hospitalisation. C. difficile causes the colon to be-come inflamed (colitis) and sometimes may form patches of raw tissue that can bleed or produce pus (pseudomembranous colitis). Signs and symptoms of severe infection include:Watery diarrhea 10 to 15 times a day,Abdominal cramping and pain, which may be severe Rapid heart rate,Fever,Blood or pus in the stool,Nausea,Dehydration,Loss of appetite,Weight loss,Swollen abdomen,Kidney fail-ure,Increased white blood cell count

Although C difficile infection (CDI) is a well- recognized cause of antibiotic-associated diarrhea, other infectious (eg, salmonellosis, shigellosis) and noninfectious causes for diarrhea should also be considered.The diagnosis of CDI is confirmed when the cytotoxin is present in the patient’s stool sample.There are other diseases like diverticulitis which is similar to C.difficile but have different treatment and should not be mistaken for having C.difficile.

Some people have loose stools during or shortly after antibiotic therapy. This may be due to C. difficile infection. See your doctor if you have three or more watery stools a day and symptoms last-ing more than two days or if you have a new fever, severe abdominal pain or cramping, or blood in your stool.Some people carry the bacterium C. difficile in their intestines but never become sick, though they may still spread the infection. Signs and symptoms usually develop within five to 10 days after starting a course of antibiotics, but may occur as soon as the first day or up to two months late.Side effects exist in almost all types of cases ,it depends upon you how well you treat and look after it.So that there is a reduction in the occurrence of it happening again.More importantly, you should follow your doctor’s advice to stay in good health.

Post treatment the patient should intake Plenty of fluids. Choose fluids containing water, salt and sugar, such as diluted fruit juice, soft drinks and broths.Good nutrition. If you have watery diarrhea, eat starchy foods, such as potatoes, noodles, rice, wheat and oatmeal. Other good choices are saltine crackers, bananas, soup and boiled vegetables. If you aren't hungry, you may need a liquid diet at first. After your diarrhea clears up, you may have temporary difficulty digesting milk and milk-based products,

Once you are back at home, you can return to your normal routine.Often, the diar-rhea will be better or completely gone before you go home. This makes giving C. diff to other people much less likely. There are a few things you should do, however, to lower the chances of developing C. diff infection again or of spreading it toothers. If you are given a prescription to treat C. diff, take the medicine exactly as prescribed by your doctor and pharmacist. Do not take half-doses or stop be-fore you run out. Wash your hands often, especially after going to the bathrooM and before preparing food. People who live with you should wash their hands often as well. If you develop more diarrhea after you get home, tell your doctoR immediately. Your doctor may give you additional instruc-tions.

This is hard to predict. Depending on your health, it can take a few weeks or several months to go away. C.difficile can come back,If you have diarrhea, fever and/or abdominal pain during treatment for C. difficile or after treatment is finished, see a doctor right away. Inform the doctor that you re-cently had C. difficile. A history of having C. difficile may change your treatment. Proper care has to be taken as per doctor’s recommendations and monitor the measures advised to maintain good health.

Price treatment for Clostridium difficile can be determined depending upon the type of treatment required as the costs vary for each type of treatment.

Up to 20 percent of people with C. difficile get sick again, either because the initial infection nev-er went away or because they're reinfected with a different strain of the bacteria. But after two or more recurrences, rates of further recurrence increase up to 65 percent.Your risk of recurrence is higher if you:Are older than 65,Are taking other antibiotics for a different condition while being treat-ed with antibiotics for C. difficile infection,Have a severe underlying medical disorder, such as chron-ic kidney failure, inflammatory bowel disease or chronic liver disease.